UNIVERSITY OF CALIFORNIA.
SURGICAL AND OBSTETRICAL
Veterinary Students and Practitioners
W. L. WILLIAMS
Professor of Obstetrics and Surgery in the New York State Veterinary
College, Cornell University.
Embodying portions of the OPERATIONSKURSUS of Dr. W. Pfeiffer,
Professor of Veterinary Science in the University of Giessen.
PUBLISHED BY THE AUTHOR
ITHACA, N. Y,
COPYRIGHT, 1903, BY
W. I,. WIHIAMS.
ANDRUS & CHUKCH
ITHACA, N. Y.
The author caused to be published in 1900 a booklet
entitled: " A Course in Surgical Operations by W. PfeifTer
and W. L. Williams, " consisting of an authorized transla-
tion of Dr. Pfeiffer's Operation s-Cursus with such changes,
omissions and additions as were deemed desirable. Three
years of constant use, with such criticisms as have come to
the author from others, have served to point out desirable
changes of so sweeping a character as to demand a practi-
cally new treatise and to render the continuance of a formal
joint authorship inexpedient. The author has drawn freely
upon Dr. Pfeiffer's Operations- Cursus in the preparation of
the text which in many chapters is practically copied there-
from, including the illustrations, and gratefully acknowl-
edges his profound obligations thereto. On the other hand
nothing has been copied or extracted except it could be freely
adopted as the author's own view, releasing Dr. Pfeiffer
from all responsibility for the character of any of the con-
The volume is primarily designed for the use of the auth-
or's classes in laboratory surgery and embryotomy in which
the student performs the surgical operations described, on
animals procured for the express purpose, under chloroform
anaesthesia whenever possible, after which the subject is
destroyed while still anaesthetized ; at the same time it has
been aimed to render the volume of the greatest possible
value to the practitioner consistent with this plan. The
operations included under this scheme are necessarily limited
to those which can be reasonably well performed on com-
paratively sound animals of little value and regularly pro-
curable for laboratory purposes. The list covers a wide
range and is designed to give to the student as thorough
training as is practicable in a laboratory course and includes
well nigh all the more important varieties of confinement,
anaesthesia, disinfection, sutures, bandaging, dressing and
other adjuncts to operative work. The chapter on trephin-
ing of the facial sinuses has been dealt with at length in
order to fully and clearly describe the author's method of
operating ; a new operation for poll evil has been inserted
and there has been included a description of some of the
most important embryotomy operations as they are carried
out in the laborator}' by means of freshly killed, new. born
calves which are placed in the position desired, in the arti-
ficial uterus of a specially prepared skeleton.
Generally but one method of operating is described, the
one chosen being that which in the author's experience has
proven the most valuable in actual practice, and no opera-
tion has been introduced purely for practice but each one
has been tested and known to have practical value.
Where two methods of operating are given, they are
inserted because each has definite points of superiority over
the other and one method may be specially applicable in a
given case, another in a different patient where the same
operation is to be performed as for example, a milk cow is
best spayed tjirough the vagina while a heifer must be
operated on by an incision through the abdominal walls.
Considerable stress has been laid upon the surgical an-
atomy of the parts involved in each operation ; some uses of
the various operations are mentioned ; some of the chief
dangers of each are pointed out and in some cases references
to literature upon the operation or the diseases for which the
operation is designed, are cited.
The figures in the text except Nos. 5, 10 and n, and the
Plates Nos. I, II, VIII, X, XII, XIV, XVII, XVIII,
XXI, XXII, XXIII, XXV, XXVIII and XXIX are from
Dr. Pfeiffer's Operations-Cursus ; Plate No. Ill was drawn
by Dr. C. F. Flocken, Bureau of Animal Industry, Wash-
ington, D. C., and the remaining Plates were drawn tinder
the direction of the author by Mr. C. W. Furlong, In-
structor in Industrial Drawing and Art in Sibley College,
W. L,. WILLIAMS.
Cornell University, October, 1903.
I. OPERATIONS ON THE HEAD :
*" i. Extraction of Teeth I
^ 2. Repulsion of Teeth n
Trephining the Facial Sinuses 18
"3. Trephining of the Frontal Sinuses 21
4. Trephining the Maxillary Sinuses 33
5. Trephining the Nasal Fossae 36
L) 6. Poll Evil Operation 37
> 7. Ligation of the Parotid Duct. _fc 41
8. Entropium Operation 1 46
9. Staphylotoniy Y 47
? 10. Trifacial Neurotomy fi 48
II. OPERATIONS ON THE NECK :
ii. Opening the Guttural Pouches 53
J2 12. Tracheotomy V?.. 59
- 13. Arytenectomy \*?- 61
14. Intra : tracheal Irrigation - 66
^15. Intravenous Injection jS. 67
/ 16. a. Phlebotomy with Fleams 69
b. Phlebotomy with Lancet 70
c. Phlebotomy with Trocar 71
17. Ligation of the Carotid Artery__ .\/. 71
1 8. CEsophagotomy 76
III. OPERATIONS ON THE TRUNK AND ON THE GENITAI, ORGANS \
Lfig. Puncture of the Chest 78
ij2o. Puncture of the Intestine 79
y2i. Subcutaneous Caudal My otomy <Si
^"22. Caudal Myectomy for Gripping of the Reins __K 83
23. Amputation of the Tail
524. Urethrotomy 9
25. Amputation of the Penis 93
^'26. Vaginal Ovariotomy in the Mare 97
27. Vaginal Ovariotomy in the Cow 1^___ 107
28. Ovariotomy in the Cow by the Flank ^1 109
29. Ovariotomy in the Bitch by the Flank __K_ no
30. Ovariotomy in the Bitch by the Linea Alba 117
31. Ovariotomy in the Cat J<__ 118
IV. OPERATIONS ON THE EXTREMITIES :
> 32. Tenotomy of the Flexor Tendons of the Foot __bf_ 119
33. Tenotomy of the Pei oneal Tendon (Stringhalt Operation ).__ 121
-"I 34. Tenotomy of the Cunean Tendon (Spavin Operation) 125
/35- Digital Neurotomy 132
736. Plantar Neurotomy_7_$*--_^- 137
jk,37- Median Neurotomy 141
38. Dinar Neurotomy 147
$39. Sciatic Neurotomy V^ 153
40. Anterior Tibial Neurotomy 163
41. Resection of the Lateral Cartilages W 165
; y 42. Resection of the Flexor Pedis Tendon J/IL 172
43. Amputation of the Claws of Ruminants V- J 74
44. Bayer's Sutures 179
EMBRYOTOMY OPERATIONS :
45. Cephalotomy _.J^ 183
46. Decapitation ___J/ 185
47. Subcutaneous Amputation of Anterior Limb y/_ 185
48. Amputation at the Humero-radial Articulation __^ 187
49. Detruncation yt 188
50. Destruction of the Pelvic Girdle, Anterior Presentation _^_ __ 192
51. Amputation of the Limbs at the Tarsus ^ 196
52. Intra-pelvic Amputation of the Posterior Limbs, Breech Pre-
sentation __V_ 200
53. Evisceration of the Fetus __i^ 209
Many details must be omitted in the succeeding text which
are of importance in each operation, but which, if inserted,
would render the volume unwieldy in size for the purpose
These details are in a measure alike in each case, and it is
assumed that the student has already familiarized himself
with them. The more important of these may be summa-
rized as follows :
1. The subject should bo securely confined in each case
as directed, because the method designated has been found
effective in the operation under description, and serves to fix
the relations of the parts in such a way as to conform to the
surgical anatomy of the region as outlined in the text. It
is to be constantly borne in mind that a change in the atti-
tude of the animal is capable of causing profound alterations
in the relations of parts which may greatly embarass the
operator, or even prevent his carrying out the operation
according to the technic given. In securing an animal for
operation we must confine the whole body in a way that will
sufficiently control movements and will insure safety to the
patient and operator ; the part to be operated upon must be
so fixed as to properly limit its motion and in a position to
afford the greatest facility for the carrying out of the opera-
tion according to the best technic known.
2. Anaesthesia should be carefully carried out everywhere
possible, because in addition to the humane sentiments in-
volved, the resulting perfect control of the animal is an
essential in aseptic or antiseptic surgery. The student
should make a careful study of anaesthesia in these exercises
and acquire invaluable experience and confidence for use in
3. Disinfection must be scrupulously applied in every de-
tail since upon its effectiveness must hang the verdict of
success or failure as measured by modern surgical knowl-
edge. The operator's hands and, if need be, his arms
should be thoroughly scrubbed with a stiff brush in hot
water with soap for a period of fifteen minutes, the finger
nails well trimmed and cleansed, and all dirt and old epider-
mal scales removed. The parts may then be disinfected by
immersing in a hot concentrated solution of permanganate
of potassium for ten minutes and then decolorized in a strong
solution of oxalic acid in sterile water. Or the hands may
be disinfected after the washing with soap and water by im-
mersing and scrubbing them for ten minutes in a i to 1000
solution of corrosive sublimate, but in order to make this
thoroughly effective the solution needs be alcoholic, or the
hands should first be immersed in alcohol, ether, or other
substance capable of dissolving fats and permitting the dis-
infectant to penetrate the sebaceous glands. Great care
should be exercised by the student to not touch any object
after the hands have been disinfected for the operation unless
it has been disinfected or sterilized, or in case it becomes
necessary to touch objects not sterile, the disinfecting process
should be repeated before proceeding further with the oper-
ation. This constitutes one of the most difficult of all details
for the beginner to acquire, and each failure should be
remedied by repeating the disinfection over and over until
the habit of maintaining effectual sterilization is acquired
The operation field should always be carefully shaved be-
fore beginning the operation, and the shaved area should
always be very ample, so as to insure against contamination
from adjacent hairs, as well as to give a clear view of the
field. The area should then be disinfected in a reliable
manner, that advised for the operator's hands serving as a
type. Whenever circumstances will permit the operation
field should be kept in an antiseptic bath or pack for twenty-
four hours prior to the operation in order that the deeper
parts of the skin, especially the hair follicles and sebaceous
glands, shall become thoroughly disinfected, a process well
nigh impossible in a short period.
The suturing, dressing and bandaging of the wound
should be carried out carefully in every case and no opera-
tion left without completing it in the best manner possible.
The student should make each operation as real as possible
and not omit any detail even if he thinks he already knows
it sufficiently well as the repetition of a supposedly familiar
detail serves an important purpose in the fixing of a habit
which is inestimably more valuable to the surgeon than any
theoretical knowledge of technic.
The safe surgeon is he who has .so accustomed himself to
the technique of asepsis and antisepsis that he carries them
out rigidly in an automatic manner and can leave his atten-
tion riveted on the surgical problems before him.
The student 'who consults his interests will go yet farther
and prior to undertaking any operation on the living subject
will study the regional anatomy of the part on the cadaver
and learn therefrom all that he can of the structure of the
part which he must finally complete upon the living animal.
No dissection of the cadaver can ever teach true surgical
structure as the dead tissues can not be like the living, but
such dissection can and does give great aid and should
be pursued as far as it can lead and enough will still remain
to be learned on the living subject.
He should further take occasion to study, in connection
with each operation the object or objects for which it is per-
formed in practice, its effect on the diseased or other parts,
the untoward results to be anticipated, etc.
Suggestions occur from time to time in the text designed
to aid the student in these lines and help weave connecting
bands between the operation, its objects and results.
Surgical operations are in themselves valueless or worse
and acquire value only when properly correlated to disease
and skillfully performed.
Surgical and Obstetrical Operations.
I. SURGICAL OPERATIONS.
OPERATIONS ON THE HEAD.
i. EXTRACTION OF TEETH.
PIRATES I AND II.
Prefatory remarks. The grinding teeth of the horse
consisting of three molars and three premolars in each row
are of such dimensions and attachments that their removal
in case of disease or defect often presents difficulties of no
These teeth attain their greatest size at the time of erup-
tion and most of the tooth remains firmly imbedded in its
alveolus while a very shallow crown projects into the buccal
cavity. The teeth are gradually pushed out of their alveoli
as their crowns are worn away with age and the proportion
of the intra- to the extra-alveolar part gradually decreases
until in very old animals the alveoli become obliterated and
the last vestige of what was once the apex of the fang rests
insecurely in the buccal mucous membrane.
The facility with which teeth may be extracted increases
as the age of the animal increases, being easily drawn with
forceps in the old, while in case of freshly erupted teeth in
the young horse we have not been able to extract them with
forceps of any kind, except in those cases where they have
become somewhat loosened as a result of disease or accident.
When aberrations in development occur, leading to the for-
mation of dental tumors or odontomes the possibilit} 7 of ex-
traction by means of forceps is frequently wholly excluded
and in cases where dental disorder has led to empyema of
the facial sinuses, even if the tooth may be drawn by means
of forceps, further operation is generally necessary, in order
2 EXTRACTION OF TEETH.
to assure a prompt recovery, by the removal of the effects
of the disease of the tooth.
The removal of molars may therefore involve extraction
with forceps, trephining the dental alveolus and repulsion
of the tooth and trephining of the sinuses because of em-
pyema or other pathologic conditions referable to the dental
affection ; consequently all of these should be studied as re-
Instruments. Extracting forceps, fulcra of various
sizes, mouth speculum with abundant lateral working room,
exporteur forceps, toothpick, splinter forceps, reflecting lamp.
Technic. In simple cases with a quiet animal the pa-
tient may be sufficiently confined by being backed into a
corner or very much better by securing in stocks. In com-
plicated cases or very resistant animals it is best to place
upon the operating table or in default of this, cast and secure
in lateral decubitis on the opposite side to the affected tooth.
Apply the speculum and identify the diseased tooth by
manual exploration ; determine if the tooth is of unnatural
size or form, if it is loose, if the gums are separated from the
neck at any point, if it is out of line with the other teeth in
the row, if it is painful to the touch, if it be split, etc. An
external tooth fistula or a tumefaction over the affected
member may aid in distinguishing it. Aid may also be had
by illuminating the mouth with a reflecting electric or other
Remove any accumulations of partially masticated food by
means of the toothpick or with the fingers.
For extracting molars use forceps acting as a lever of the
first class-, with a fulcrum having a plane and a convex sur-
face ; for the premolars use forceps acting as a lever of the
second class. In case of the superior premolars some prefer
forceps bent on the flat as shown in Plate II, because if
straight the forceps handles strike against the superior in-
cisors and hinder the deep fixation of the forceps jaws upon
the tooth crown.
EXTRACTION OF TEETH. 3
In applying the forceps to the tooth have an assistant draw
the tongue well out at the commissure of the lips on the side
opposite to the affected member and introducing one hand
into the mouth, place the index finger on the posterior
border of the diseased tooth and with the other hand push
the opened forceps backwards upon the tooth row until they
reach the finger, then firmly grasp the affected tooth with
the instrument, pressing the jaws down as deeply as possible
against the alveolus. In many cases the diseased tooth can
be clearly seen especially with the aid of the reflecting lamp
and the forceps readily applied with visual aid and is fre-
quently preferable to the guide of touch. Withdraw the
free hand from the. mouth, grasp the handles with both
hands and loosen the tooth in its alveolus by establishing
and maintaining as long as necessary a gentle to and fro
lateral movement. The tooth is thus loosened in its alveolus
by causing it to revolve very slightly back and forth on its
long axis. When the tooth has become well loosened, as
indicated by its moving with the forceps and by the audible
crackling sound caused by the passage of air bubbles to and
fro through the blood and lymph in the alveolus ; maintain
the forceps in position with one hand and with the other
introduce the fulcrum as far back as possible in the case of
molars and place it with the plane surface resting upon the
crowns of the teeth as shown in Plate I. The fulcrum
needs be held firmly in place in order to prevent it from
gliding forward under pressure.
The tooth fang is extracted by forcing the handles of
the forceps toward the jaw in which it is located, so that
as it is gradually drawn out the forceps tend to glide over
the convex surface of the fulcrum in a way to permit the
tooth to emerge from the alveolus in the direction of the
long axis of the latter. By referring to Plate III it will be
seen that the axes of the different teeth vary, that of the
molars being obliquely forwards toward the incisors while
the crowns of the premolars are directed obliquely back-
EXTRACTION OF TEETH.
Sagittal section through the oral cavity, show-
ing plan for extracting the first inferior molar,
viewed from within the mouth.
EXTRACTION OF TEETH. 7
wards from the incisors. The slant of the teeth is most
marked at the ends of the row and at the middle they
acquire a practically perpendicular position. In drawing
the last molar the forceps will generally strike against
the opposite row of teeth before the tooth has com-
pletely emerged from its socket and in order to complete its
removal it may be necessary to take a deeper hold with the
forceps or remove with the exporteur forceps or with the
fingers. In young horses where the teeth are very long we
have found it impossible to complete the extraction until the
tooth had been divided transversely by means of the tooth
With the premolars the fulcrum is placed beneath the ex-
tension beyond the jaws of the forceps which through its
fulcrum then rests upon the grinding surface posterior to the
diseased tooth and permits it to be withdrawn obliquely from
before backward in its normal line of direction.
The dangers in the extraction of teeth are chiefly :
1. The fracture of the tooth crown leaving the fang still
fixed in the alveolus, a danger not infrequently unavoidable
when the crown has become greatly weakened by disease so
that it wants the power of resistance necessary to its extrac-
tion ; under most other conditions it may be largely guarded
against by the careful securing of the patient in a manner
to effectively prevent sudden throwing of the head while the
forceps are applied, and by using good judgment in the
amount of force used while loosening the tooth in its alveolus.
2. Fracture of the alveolar walls is an accident which may
generally be prevented by proper care in the application of
force and the avoidance of any attempt to extract a tooth
when the existence of an enlargement of the fang is apparent
3. The tooth may slip from the forceps into the pharynx
and be swallowed, an accident avoidable by inserting the
hand into the mouth along with the forceps as the tooth be-
gins to emerge and if need be grasp it with the fingers.
EXTRACTION OF TEETH.
Sagittal section through the walls of the oral
cavity illustrating plan for extracting the sec-
ond superior premolar.
REPULSION OF TEETH. 1 1
2. REPULSION OF TEETH.
Uses. The removal of molars, pre-molars, tooth fangs
from which the crowns have been broken away, alveolar
odontomes, etc., which can not be removed safely by means
of the forceps.
Instruments. Razor, convex scalpels, trephine, bone
gouge, Luer's sharp bone forceps, light and heavy bone
chisels, mallet, tooth punch, curette, compression artery
forceps, scissors, needles, thread, absorbent cotton, antiseptic
gauze, extracting forceps, splinter forceps, dressing forceps,
tenacula, metal probe, mouth speculum.
Technic. Secure the animal in the lateral recumbent
position with the affected side up. The operating table
affords by far the best means for securing for the conven-
ience and safety of operator and patient. If the sinuses are
so involved as to make possible the inhalation of pus, blood
or other injurious matter, perform tracheotomy in ample
time to avert danger. Anaesthetize. Shave and disinfect
the operative area and trephine according to the method
described in the following chapter down through the alveolar -
plate immediately over the fang of the affected tooth. Avoid
dulling the trephine by striking it against the tooth fang
itself. If a tooth fistula exists the identity of the affected
tooth is best determined by passing a metallic probe through
the fistula against the diseased fang while one hand is passed
into the mouth and the location of the probe ascertained.
Care should be exercised in trephining to not injure the ad-
joining teeth. After removing the disc of bone isolated by
the trephine, control all hemorrhage and then enlarge the
opening and remove the bony tissues till the tooth fang is
bared its entire width. Insert a scalpel between the bone and
soft tissues at the margin of the trephine opening nearest the
12 REPULSION OF TEETH.
mouth and with one hand in the oral cavity with the fingers
resting upon the alveolar border on the lateral side of the
tooth to serve as a guide, push the scalpel along between
the bone and soft tissues until it emerges from the gums
alongside the affected tooth and extend this incision back-
wards and forwards until the soft tissues are completely de-
tached from the alveolar wall over the entire area of the
diseased member. With a light, narrow bone chisel cutaway
and remove the entire external alveolar plate throughout
the extent of the tooth, from the oral margin of the trephine
opening into the mouth cavity. Hold the chisel so that the
outer edge is inclined from the affected tooth toward the
adjoining one, thus making a bevelled channel through the
alveolar plate which tends to loosen and detach the section
of the alveolar wall to be removed without injury to that
adjoining. Drive the chisel for a short distance only on one
side and then apply it to the other side in order to detach
but small pieces of bone at one time avoiding the detachment
of large sections of the plate at once and having it extend to
neighboring alveoli. With gouge and chisel remove all
remnants of bone over the lateral side of the tooth laying it
completely bare as shown in Plate III. The soft tissues of
the part should not be disturbed beyond the removal of the
circular piece over the disk of bone removed by the trephine
and detatching them from the portion of bone to be chiseled
away. When the tooth has been bared so that every part of
its lateral surface can be seen or felt, the punch may be placed
against the end of the fang, a few firm, quick blows given
with the mallet, so directed that the force is in a line with
the long axis of the tooth, driving it into the mouth where
it is seized by the forceps or the hand and removed. If it
is not readily and safely dislodged in this way, place the
heavy bone chisel against it and with the aid of the mallet
comminute the tooth by breaking it transversely and splitting
it longitudinally, in which process the fragments are gener-
S !S a
I !/ s
2 S b
a flJ ~ w
w 1 s s
6 <i "o
1 6 REPULSION OF TEETH.
ally loosened and can then be readily removed with the aid
of the gouge or forceps. Remove carefully all fragments of
tooth or of loosened bone, cleanse and disinfect the wound,
pack with iodoform gauze and dress daily.
In cases where a fistulous opening remains after repulsion
of molars in the usual manner without the removal of the
alveolar wall, or if a tooth has been drawn by means of the
forceps and the alveolus fails to heal, the bony plate should
be removed in the same manner as indicated for the removal
of the teeth.
Dangers. Wounding of neighboring teeth, fracture of
the inferior maxilla, fracture of the bony palate.
Wounding of the adjoining tooth is to be avoided chiefly
by carefully locating the fang of the affected one and
placing the center of the trephine as exactly as possible over
the center of the tooth, by using a trephine not exceeding
2 to 2.5 cm. in diameter and cautiously trephining through
the compact layer of the external plate only, removing the
cancellated tissue with the gouge and extending the opening
in the desired direction after the outlines of the tooth fang
have been clearly determined. If an adjoining fang is
wounded the tooth should be removed as it will not heal but
will result in a permanent tooth fistula.
The fracture of the alveolar walls of the inferior maxilla is
to be constantly guarded against by being cautious to see after
each stroke on the punch that it has not slipped inward along
the median side of the tooth, pressing the internal plate away
from the tooth row and tending to produce a longitudinal
fracture nearly or quite as long as the dental arcade. Careful
digital exploration in the mouth may discover this fracture
while still " simple " but a stroke or two more will convert it
into the very much more serious " compound " fracture open-
ing into the oral cavity. Keeping one hand constantly in the
mouth at the point of impact is always desirable as a precau-
tionary measure. Transverse fracture of the tooth while
REPULSION OF TEE TH. 1 7
yet in situ by means of the bone chisel, as above described,
is a great safeguard against this injury by lessening the force
required in repulsion and by the removal of the tapering
fang, which then leaves a more secure base for the punch to
act upon. It should never be forgotten that the impact from
the punch must always be as nearly parallel to the long axis
of the tooth as is possible.
The fracture of the superior maxilla and bony palate is
not so probable as the preceding and is preventable by mod-
erate care in the baring of the tooth before punching, by
comminution of the tooth in bad cases, by the careful ad-
justment of the punch and applying the force in the proper
Literature. Odontomes, Sir Bland Button, Jour. Comp.
Med. and Vet. Arch. Vol. XII, p. i ; A Clinical Study of
Odontomes, W. L. Williams, Am. Vet. Review, Vol. XV,
p. i ; Notes on Odontomes, do ; Am. Vet. Rev. Vol. XXIII,
p. 82 and Oest. Mon. Thierheilkunde, Bd. XXIV, s. 122.
1 8 TREPHINING OF THE FACIAL SINUSES.
TREPHINING OF THE FACIAL SINUSES.
PIRATES IV, V, VI, VII.
Prefatory Note. The facial sinuses of the horse consti-
tute an exceedingly intricate and extensive group of cavities,
communicating more or less freely with each other and with
the exterior through the medium of the upper air passages,
of which they are to be regarded as a part.
Their arrangement and relations permit them to frequently
become the seat of, or central figure in many forms of disease
which require for their differential diagnosis, amelioration or
cure, the operation known as trephining. Their extent and
relations to each other and to surrounding parts varies
greatly with age and may be profoundly changed as a result
of disease, amounting not infrequently in the frontal,
superior and inferior maxillary sinuses ceasing to exist as
separate cavities arid becoming merged into one vast diverti-
culum. Similar changes ma} 7 occur in the nasal and lur-
binated cavities. The general position, extent and relations
of these are indicated by Plates IV, V, VI and VII.
The uses of trephining are in a measure common to all
the cavities involved and are chiefly for the relief of
empyema of the cavities involved, necrosis of the bony or
cartilaginous walls, tumors of various kinds, especially dental
tumors in the young and malignant growths in the old,
foreign bodies in the sinuses, differential diagnosis of diseases
of this region, etc.
Veterinarians trephine the sinuses by two fundamentally
different plans; with, and without excision of the cutaneous
disk corresponding to the piece of bone removed. The first
is generally used in Great Britain and North America while
the last is the prevailing method in continental Europe and
other parts of the world. The reasons for these variations in
method have not been given so far as we know. To us
TREPHINING OF THE FACIAL SINUSES. 19
there seem to be adequate reasons for preferring the excision
of the cutaneous disk. We regard as the chief considera-
tions in an operation the following : the avoidance of infec-
tion ; the prevention of pain during the operation or the
after-treatment ; the reduction of the scar to a minimum ;
rapidity and certainty of recovery ; convenience in operating
and dressing. Infection is largely dependent, aside from
aseptic operation and protective dressing, upon the area of
the wound, the facility for maintaining cleanliness and the
degree of disturbance to the tissues while being dressed.
The wound area in the bone is alike in all cases but that in
the skin varies greatly. Jf we take as a type the usual Ger-
man technic and compare it with that given below we would
find the wound areas approximately as follows : in the Ger-
man method, an incision 2. 7 in. (7 cm. ) long which assuming
that the skin is f\ in. thick would yield an area of 2.7" X 2 =
5.4" X y\" = J sc l- }u - The subctitem is then separated
from the periosteum and the skin drawn apart far enough to
admit of the insertion of, say, a -J" trephine giving 2 triangles
each having a base of 2.7" in. and a perpendicular of yV'-
or an area of 2.7" X T y = 1.2 sq. in. ; thus giving a total
wound area of 2.2 sq. in. Assuming the same thickness of
skin and the same size of the trephine in the operation as
given belovy we have only the wound caused by the circular
incision which would measure " X 3.1416 = 2.7" in cir-
cumference X y\" = .44sq. in. or proportionately the wound
area in the soft tissues in the German operation to that given
below would be as 5:1.
It is very evident that the technic below given affords
immeasureably better facility for maintaining cleanliness in
the wound and with a minimum amount of insult to the
tissues in the process of dressing.
The amount of pain caused in the operation would depend
chifly on the extent of the skin incision which is equal in
the two plans so that the only difference would be in the dis-
20 TREPHINING OF THE FACIAL SINUSES.
section of the skin from the bone in the German operation.
The pain caused in dressing must be greater in the German
method because the detached, overhanging skin must be
moved and disturbed each time causing pain and inviting
infection. The question of pain must always be seriously
considered as it not only affects the time required for dressing
and its efficacy, but has an important relation to the docility
of the animal after recovery, some horses having their dis-
positions permanently ruined by the irritation due to the oft
repeated painful dressing of wounds.
The cicatricial contraction of the tissues of the horse is
so great that the removal of a circular disk of skin "/%" to
i%" in diameter on the face does not leave a visible scar so
that the question of blemish falls back upon that of infec-
tion which we have asserted above is far more probable by
the German method.
The rapidity and certainty of recovery are dependent on
considerations above discussed. The removal of the cuta-
neous disk is certainly easier and quicker than the other
method. The convenience for dressing is evidently superior
by the English and Amercan method.
The opening of the maxillary sinuses into the nostrils is
based upon the surgical principle that suppurating cavities
should be provided with ample drainage from the most de-
pendent part. The direction to leave the external wound
open may at first thought seem antagonistic to general sur-
gical principles but it should be remembered that the wound
consists only of the incision through the skin, connective
tissue and bone and that any plug which we can put in this
opening can only serve to dam the secretions of the cavity
back and can not prevent it from coming in contact with the
wounded surface. It must further be regarded that the
respirator)' mucosa of the upper air passages are not irritated
or injured in any manner so far as we can observe clinically
by the direct admission of air into them through a trephine,
or other artificial opening.
TREPHINNIG OF THE FRONTAL SINUSES. 21
3. TREPHINING OF THE FRONTAL SINUSES
Uses. Fracture of the bony walls, necrosis, tumors.
The ample communication below with the superior maxil-
ary sinuses prevents the accumulation of pus or fluids in the
frontal cavities even if formed therein unless the opening
between the superior maxilary sinus and the nasal fossa at N,
Plates V and VI becomes blocked, preventing the escape
of fluids through the latter and causing them to fill the
superior maxilary sinus and then back up into the frontal.
In case of empyema of the frontal sinus, trephining does not
give full relief but calls for a repetition of the operation on
the maxilary sinuses also.
Instruments. Razor, scissors, convex scalpels, artery
forceps, tenacula, probe, trephine, curette, gouge, Luer's
sharp bone forceps, hammer, chisel, bone screw, lens-shaped
bone knife, probe-pointed bistoury, dressing forceps, disin-
fecting and dressing materials.
Technic. Operate on the standing animal with the aid
of the twitch or secured in stocks, with local anaesthesia or
secure on the operating table or cast in lateral recumbency on
the sound side. Clip and shave the hair from the region of
the frontal bone on a level with the superior border of the
orbital cavity as indicated in Plate IV and disinfect the area
carefully. Within the shaved and disinfected area locate the
point for trephining, F, Plate IV, so that the inferior border
of the opening will be on a level with the superior border of
the orbital cavity at the dotted line below F and the inner
margin about i cm. from the median line of the face. With
a heavy convex scalpel make a circular incision as large as
the area of the trephine, directly through the skin, subcutem
and periosteum down to the bone and remove in one piece
the entire mass of encircled soft tissues by seizing the skin
with a tenaculum and forcibly separating the periosteum
TREPHINING THE FACIAL SINUSES.
F, opening into frontal sinus ; N, opening
into nasal sinus ; SM, opening into superior
maxillary sinus ; IM, opening into external por-
tion of inferior maxillary sinus ; IM', opening
into the median portion of the inferior max-
TREPHINING OF THE FRONTAL SINUSES. 25
from the bone with a scalpel or bone scraper. Control the
hemmorhage. With the center-bit extended place the tre-
phine accurately upon the denuded area, perpendicular to
the surface of the bone, and by revolving it to and fro force
the center-bit into the bone and continue until the trephine
has cut a distinct furrow, when the center-bit should be
withdrawn and the operation continued, being careful to
maintain the trephine perpendicular to the bone. The ope-
ration is facilitated by grasping the shaft of the trephine be-
tween the thumb and fingers of one hand, constituting a
support in which it can glide back and forth. The pressure
under which the sawing is carried out must not be too great.
When the bony plate which has been sawed around begins
to loosen, remove the trephine and insert the bone screw
into the centerbit opening and break out the piece of bone
or pry it out with the bone gouge or chisel. Smooth any
uneven edges of bone with the lens-shaped knife. The ab-
normal contents of the frontal sinus can now escape through
the opening or be removed with the curette, forceps or scis-
sors, and the cavity irrigated with an antiseptic fluid. Leave
the trephine wound entirely open and dress daily with anti-
septics.^ The frontal sinuses are in free communication with
the superior maxillary and with the superior turbinated bone
of the same side so that indirectly the irrigating fluid can
escape through the nasal opening by way of the maxillary
sinus or of a perforation through the superior turbinated
In order to prevent the aspiration of the contents which
are generally purulent, or ma}' consist of blood or irri-
gating fluids, and to facilitate their escape, irrigation
must be carried out with the poll elevated and the head
By studying Plates IV and V it will be seen that any
collection of pus or other disease products at F would
result in poor drainage so far as may be obtained by
TREPHINING THE FACIAL SINUSES.
Cross section of the left side of the head of an
aged horse at the second molar, seen from the
front. F, frontal sinus ; N, nasal sinus, oppo-
site the communication between the nasal and
inferior maxillary sinuses ; IM, lateral portion
of inferior maxillary sinus ; IM / , median portion
of inferior maxillary sinus ; SM, superior max-
illary sinus ; NF, superior maxillary division of
trifacial nerve in its bony conduit; SZ, subzygo-
matic artery ; P, palatine artery ; M2, second
TREPHINING OF THE FRONTAL SINUSES. 29
trephining through the external wall only, and consequently
in order to complete the drainage aside from that through
the superior maxillary sinus an artificial communication be-
tween the frontal sinus and nasal fossa may be made at ST,
Plate VII, by first making a second trephine opening op-
posite that point near the median line and then breaking
through the thin walls of the turbinated bone by means of
a probe or other suitable instrument and enlarging the open-
ing sufficiently with the probe pointed bistoury or with the
finger. In order to prevent aspiration of fluids, the animal
must be allowed to get up immediately or if under anaes-
thesia a trachea tube should be inserted sufficiently early to
avoid danger. Thread a long probe with a heavy silk suture
about 75 cm. long and inserting it through the trephine
opening into the nasal passage draw it out through the
nostril and removing the probe attach a strip of gauze
75 cm. long to one end of the suture, draw it out through
the nostril and tie the ends of the gauze together on the side
of the face to prevent dislodgement. Retain the gauze
in position for about forty-eight hours to insure the per-
manency of the opening through the turbinated bone. In
case of severe hemorrhage the cavity can be tamponed for
twenty-four hours with a long strip of gauze which may
be secured if necessary by suturing to the lips of the wound.
In practice the operation can be best carried out generally
with the animal in the standing position the operative area
being first anaesthetized by the use of cocaine or by inducing
artificial oedema. In the standing position we largely avoid
the danger of aspiration of fluids and the hemorrhage is
TREPHINING THE FACIAL SINUSES.
Cross srction, slightly oblique, through left
half of head at fiist molar in a two year colt.
F, frontal sinus ; N, nasal sinus at point of com-
munication with the inferior maxillary sinus,
IM ; IM', median portion of inferior maxillary
sinus; SM, superior maxillary sinus ; Mi, first
molar ; M2, second molar ; P, palatine artery ;
SZ, sub-zygomatic arttry.
~~>^ ' '
TREPHINING THE MAXILLARY SINUSES. 33
4. TREPHINING THE MAXILLARY SINUSES.
Uses. Empyema, diseased teeth, odontomes, tumors.
Instruments. Same as for the frontal sinuses.
Anatomically there are two maxillary sinuses, superior
SM, and inferior IM, Plates IV, V, and VI, having a thin
imperforate bony partition between them. This partition
shifts somewhat in position with age and in case of disease
undergoes profound changes in location and is frequently
totally. obliterated in cases of empyema, dental cysts and
other affections, so that clinically in many cases its location,
existence or non-existence is of scant interest. If present,
good drainage of the superior sinus usually demands its
surgical destruction so that most authors advise trephining
directly over this partition in order to open the two sinuses
simultaneously. In extensive disease the prior destruction
of the partition renders such an operation superfluous ; in
limited disease the opening of both cavities is ill advised.
The partition should be ignored in operating for extensive
disease and the trephine opening be aimed at the probable
focus of disease and, if missed, it should be located through
the primary, or what now becomes an exploratory opening
and a second operation made to directly reach the seat of the
affection and if need be, yet a third to secure proper drain-
age. Shave and disinfect as much of the area as may be re-
quired bounded above by the inferior border of the orbital
cavity, laterally by the zygomatic ridge, inferiorly by the
lower end of the zygomatic ridge and medianwards by the
middle line of the face. Determine the proper point for
operation by percussion or otherwise. If it is desired to
enter only the superior maxillary sinus, SM, Plates V and
and VI, locate the opening immediately beneath the orbital
cavity and in front of the zygomatic ridge, SM, Plate IV, or
at any point directly beneath this to within about 3 or 4 cm. of
34 TREPHINING THE MAXILLARY SINUSES.
the inferior end of the zygomatic ridge at about the level of
the dotted line IM'. In order to penetrate the inferior
maxillary sinus the trephine opening needs be located just
in front of the lower end of the zygomatic ridge at IM, Plate
IV, or on a line obliquely upwards therefrom as far as the
furrow marking the suture between the maxillary and nasal
bones at IM'. The trephining is carried out as described
for the frontal sinuses. After the trephine opening has been
made remove any purulent collection or tumors or carry out
any other necessary operation in the affected sinuses and
after cleansing, if the trephine opening does not insure per-
fect drainage of the lateral sac, either lower the opening
already made by cutting away its inferior border with the
bone forceps or make a second trephine opening at the neces-
sary point. The median portion of the sinuses on the
median side of the bony conduit of the trifacial nerve NF,
Plates V and VI, can not be drained properly through these
openings SM and IM, Plate IV, and provision for their
drainage must generally be made by making a trephine open-
ing into the inferior maxillary sinus at IM', Plate IV, and
then make an opening 3 to 5 cm. in diameter through the in-
ferior turbinated bone at IT, Plate VII, either with the
ringer, probe-pointed bistoury, or other suitable instrument,
and inserting through this opening a long and thick strip of
gauze which is brought out through the nostril and the ends
tied together on the side of the face to prevent displacement.
Retain this in position renewing daily until the permanency
of the opening is assured.
If the partition between the two sinuses is intact it w r ill be
necessary to destroy it immediately above IM', Plate IV, in
order to drain the median portion of the superior maxillary
sinus if that is required. If a molar has been removed and
in so doing the bony wall leading down from the nerve con-
duit NF, Plates V and VI, to the fang of the molar has been
destroyed in the operation, sufficient drainage may be af-
TREPHINING THE MAXILLARY SINUSES. 35
forded into the mouth and the opening through the turbinated
bone be rendered unnecessary. Leave all wounds entirely
open and irrigate daily with antiseptic solutions.
Dangers. Care must be exercised to not injure the
superior maxillary division of the trifacial nerve, NF, Plates
V and VI, either in trephining or after the sinuses have
been opened. The bony conduit of this nerve is in rare
cases entirely resorbed by pressure from dental cysts or other
causes, leaving the nerve stretched across the cavity as a
white nacrous cord, intensely sensitive. Any injury to this
'nerve causes intense pain and renders the animal very re-
sistant to the necessary manipulations in the after care of
the wound and may leave it permanently nervous about the
handling of its face.
Hemorrhage is generally not severe and may occur from
the skin, where it should be controlled by compression or
ligation ; from the inter-osseous vessels, where it may be
controlled by pressure with absorbent cotton, by pushing a
small portion of the cotton into the channel of the vessel
with a needle or tenaculum or by plugging the vessel with a
conical piece of wood ; from the wounded turbinated bones
where it may be controlled by packing with cheese cloth.
These tampons should be removed after twenty-four hours.
36 TREPHINING THE NASAL FOSSAE.
5. TREPHINING THE NASAL FOSSAE.
Uses. Operations on the septum nasii, upon the tur-
binated bones, the removal of tumors or foreign bodies.
Instruments. Same as for the frontal sinuses.
Technic. The trephining is carried out by the method
described above, in the region of the nasal bone, close by
the median line of the face and according to indications at
any point from a level of the dotted line SM, Plate IV, to
the upper extremity of the false nostril. The operation
should be immediately against the median line since other-
wise the frontal or superior turbinated sinuses may be
opened, the highly vascular superior turbinated bone
wounded or an important inter-osseous artery in the nasal
bone just above its union with the superior turbinated bone,
as shown in Plate VI, may be severed. Special care is also
necessary that the trephining should not be carried too
deeply and that the disc of bone be carefully removed in
order to avoid wounding the highly vascular turbinated
bone which lies in close proximity to the nasal bone. The
operative area is narrow and the trephine used should not
exceed 2 cm. in diameter. Whenever possible the opera-
tion should be carried out on the standing animal which de-
creases the hemorrhage and the danger from aspiration of
fluids. Even in the standing animal, if extensive operations
are to be carried out on the very vascular septum nasii or
on the turbine it is generally advisable to perfoin trache-
otomy before trephining, and retain the trachea tube in
position until all danger has passed. When the animal is
confined in the recumbent position the patient's safety de-
mands that tracheotomy be performed before the operation
is begun in almost all cases. Anaesthesia may be maintained
in such cases by means of an ordinary funnel with its spout
bent at right angles and inserted into the trachea tube while
POLL EVIL OPERATION. 37
the chloroform is dropped on a towel spread over the mouth
of the funnel. After completing any required operation on
the septum, turbinated bones or other parts, hemorrhage
may be controlled by plugging one or both nasal fossa with
single strips of gauze of sufficient size and carefully se-
curing them by sutures to the sides of the trephine wound
6. POLL EVIL OPERATION. >
Instruments. Clipping shears, razor, sharp scalpels,
probe-pointed bistoury, probe, Luer's bone forceps, bone
gouge, curette, suture and dressing material.
Technic. Confine the animal in lateral, decubitis prefer-
ably upon the operating table, place under complete anaes-
thesia and remove the halter or other headgear. Clip the
foretop and mane and shave the forehead and the top of the
neck back to a distance of 8 or 10 cm. and behind the sup-
posed extension of disease, and disinfect the area. With a
sharp scalpel make a longitudinal incision on the median line
of the head and neck beginning at a point presumably posteri-
or to the diseased area and carrying it over the poll down onto
the forehead for a distance of 4 or 5 cm. below the foretop.
Continue this incision through the skin, the subcutem, the
adipose tissue, AT, Plate VII, and either through or passing
around alongside the neck ligament, L,N, into the diseased
area beneath the latter. Dissect the ligamentum nuchae
away from the adjoining tissues as far back as diseased and
divide obliquely upward and backward as indicated at AA,
Plate VII and detach anteriorly from the base of the occiput.
Be careful to remove every portion of the ligament in the
area indicated and remove all calcareous deposits or diseased
tissues. With Luer's forceps groove a channel about 2 cm.
wide from behind to before through the occipital protuber-
r c J*
V OF THE
LIGA TION OF THE PAROflf^fJVCT. 41
ance to the depth of about 2 cm. making the bottom of the
groove as near as possible on a level with the bottom of the
wound in the soft tissues as indicated by the dotted line, AA,
Plate VII. Using Liter's forceps as a curette detach all
vestiges of the neck ligament from the base of the occiput
and leave the bone bare and smooth. Be careful to avoid
penetrating the cranial cavity or the occipito-atloid articula-
tion. Control the hemorrhage, cleanse and disinfect the
wound, pack with iodoform gauze and sutine for its entire
length except the anterior part where the packing should
slightly protrude and dust the margin of the wound over
with iodoform and tannin. Remove the pack after forty -
eight hours and dress antiseptically daily. The sutures may
or may not be removed according to conditions. In carrying
out this operation our chief aim should be to remove all
diseased parts, to afford perfect drainage anteriorly, to secure
and maintain asepsis, and to keep the wound directly on
the median line from which no visible scar will result.
7. LIGATION OF THE PAROTID DUCT.
Objects. The destruction of the parotid gland in case of
fistula from wounds or abscesses.
Instruments. Razor, convex scalpel, straight probe-
pointed scalpel, teiiaculiini forceps, ligation forceps, tenacula,
needle holder, probe, suture and dressing material.
Technic. In case of salivary fistula insert a probe
through the fistula into the duct toward the gland and with
a sharp scalpel la)* the parotid duct free for a distance of
from i to 2 cm. on the glandular side of the fistulous open-
ing. If the fistula has its location on the side of the cheek,
cast the horse and shave and disinfect the region on the
inferior maxilla where the artery, vein and parotid duct
turn around its inferior border. When the operator glides
his finger over the vascular region from before backward
LlGATlON OF THE PAROTID DUCT.
Fig i. Segment of the left ranms of the in-
ferior maxilla of the horse seen from the right
and beneath, sp, usual operative field ; , ex-
ternal maxillary artery ; v, external maxillary
vein ; st, st, parotid duct.
Fig. 2. Life size of operation field at sp, fig. i ;
fl, external maxillary artery ; v, external maxil-
lary vein ; st, parotid duct ; m, masseter muscle.
LIGATION OF THE PAROTID DUCT. 45
there is felt a resistant cord, the external maxillary artery
about 3 mm. in diameter, pulsating in the living animal.
Between this and the oral border of the masseter muscle make
an incision about 4 cm. long parallel with the artery through
the skin and skin muscle. This incision is more readily
made by gathering up a fold of skin about 2 cm. high and
cutting through this. Pick up the loose connective tissue
with a pair of forceps and excise it. Immediately behind
the external maxillary artery, a, Figs. I and II, Plate VIII,
is the external maxillary vein v and behind this and immedi-
ately on the border of the masseter muscle lies the parotid
duct, st. In case ot' salivary calculi which cannot be re-
moved through the mouth and cystic dilation of the par-
otid duct, make the cutaneous incision at the affected
point, open the parotid duct, and after the removal of the
calculus, etc., close the duct wound by means of intestinal
sutures in such a way that the external surfaces of the lips
of the wound in the wall of the duct are brought in contact,
or ligate the duct on the proximal side of the point of opera-
tion. Legation is accomplished by passing a strong silk
thread behind the duct by means of a curved needle carry-
ing it around the duct and tying with a surgeon's knot.
The parotid duct can also be previously split and an internal
wound made at the point of ligation. Close the skin wound
by means of a continuous suture and cover the operative
surface with iodoform collodion or with wound gelatine.
46 ENTROPIUM OPERATION.
8. ENTROPIUM OPERATION.
Instruments. Razor, convex scalpel, tenaculum and
ligation forceps, tenacula, needle holder, needles, thread,
Technic. Quiet adult horses may be operated upon in
the standing position with the aid of local anaesthesia, other
horses and small animals should be secured in lateral re-
cumbency preferably upon the operating table. Shave and
disinfect the skin of the inverted eyelid. Grasp the skin of
the eyelid midway between the inner and outer canthi
either with the fingers or the forceps and elevate a skin fold
parallel with the border of the eyelid to such a height that
the inverted member assumes its normal position. Pass
Entropium operation on the superior and inferior eyelids of the dog.
one finger into the conjunctival sac to make sure that the
conjunctiva is not drawn into the skin fold. Clip the fold
off with the scissors immediately below the forceps, remov-
ing an oblong piece. Between the border of the eyelid and
the border of the wound the skin should be left intact for at
least .5 cm. Ligate any bleeding vessels and close the
wound by means of interrupted sutures. The wound
may be covered with iodoform collodion or wound gelatine
or dusted over with iodoform-tannin. It is usually un-
necessary and inadvisable to cover the parts with hood or
other appliance since so long as the wound is healing
properly the animal will not disturb it.
Object. An operation devised by Dr. M. H. McKillip
for making a manual exploration of the Eustachian tubes,
guttural pouches, pharynx and posterior nares ; and for
operations upon these structures. The form and extent of
the soft palate of the horse is such as to render it extremely
difficult to make a manual exploration of the parts above
and behind it, and impossible to make a visual examina-
tion except with the aid of the expensive and complicated
rhino-laryngoscope, which only aids in diagnosis while
staphylotomy combines with this operative advantages, per-
mitting the free introduction of the hand into the laryngo-
Instruments. Mouth speculum, short curved probe
pointed bistoury with a ring to fit the middle finger.
Technic. Cast the patient or secure on the operating
table in lateral recumbency and turn the nose upward.
Adjust the mouth speculum and open the mouth as wide as
possible ; draw the tongue well out with the left hand while
the right carrying the knife on the middle finger is passed
carefully through the fauces until it hooks over the posterior
border of the soft palate. /The knife is then gently drawn
forward making an incision along the median line of the
soft palate from its posterior, free border to its attachment
on the palatine bone. The hand is then withdrawn and the
speculum removed for a few minutes to permit the patient to
rid its pharynx of any blood clots or mucus that may have
accumulated. Readjusting the speculum as before, the
right hand is again passed through the fauces and now that
the palate is divided a digital exploration will perfectly re-
veal the presence of any abnormality in the region.
48 TRIFACIAL NEUROTOMY.
10. TRIFACIAL NEUROTOMY.
Object. The relief of involuntary shaking of the head.
Instruments. Razor, scissors, convex scalpel, tenacula,
aneurism needle, compression artery forceps, needles, thread,
absorbent cotton, a strong piece of muslin 12 cm. square.
Technic. Secure in lateral recumbency, preferably upon
the operating table, and produce complete anaesthesia. Re-
move the halter, bridle, or other head gear. Shave and dis-
infect an area 8 to 10 cm. square over the infra-orbital fora-
men. Locate by touch the infra-orbital foramen, IOF, Plate
IX, below the levator labii superioris proprius muscle and
displace the latter, LL, down wards toward the inferior maxilla
until the foramen can be felt above the muscle. By pushing
this muscle downward the branches of the glosso-facial
vessels which lie chiefly below it are pushed downward with
the muscle so that the incision can be made without wound-
ing them. Begin the incision i cm. above the foramen and
carry it down directly over the middle of the nerve a distance
of 5 or 6 cm., through the skin, subcutem and the levator
labii superioris alaque nasii muscle, laying bare the nerve
NF, where it emerges from the foramen. Let an assistant
hold the lips of the wound apart and the levator muscle
downwards with two tenacula, dissect away the connective
tissue surrounding the nerve until the latter is clearly de-
fined, pass the aneurism needle beneath the nerve from
above downwards being especially careful to include the
uppermost or dorsal twigs, and passing a curved probe-
pointed scalpel or the blade of a pair of scissors underneath
it, divide the nerve at the foramen, grasp the distal end with
forceps and excise a piece at least 3 cm. long being careful
to include all branches. Control the hemorrhage very care-
fully. Cleanse the wound, sprinkle with iodoform and close
TR I FACIAL NEUROTOMY. 49
with continuous sutures. Place the square piece of muslin
centrally over the wound and fix it securely to the .skin by
means of strong sutures at each corner, in order to protect it
while the other nerve is being cut. Turn the animal to the
opposite side and repeat the operation on the other nerve
except the application of the square piece of muslin which
is here unnecessary. As soon as the animal stands, remove
the protective piece of muslin from the first wound, disinfect
both wounds, dust them over with iodoform and tannin or
cover with wound gelatine and leave undisturbed to heal by
primary union. Avoid halter, bridle or other fixtures which
might injure the wounds after the operation.
Dangers. The chief danger in the operation is from in-
fection, which sets up a severe neuritis in the proximal end
of the nerve, aggravates the symptoms and causes much
suffering. In order to prevent infection the aseptic precau-
tions need be unusually strict in every detail and the anaes-
thesia profound. Carefully avoid wounding the neighbor-
ing vessels and control completely any hemorrhage that
occurs in order to avoid a hematome in the wound, which
would invite infection.
Literature. Involuntary twitching of the head relieved
by trifacial netirectomy. W. L,. Williams, Jour. Comp.
Med. and V. A., vol. XVIII, p. 426. Involuntary shaking
of the head and its treatment by trifacial neurectomy. do.
Am. Vet. Rev., vol. XXIII, p. 321 and (Est. Monatsch.
Thierheilkunde, Bd. XXIV, s. 211.
LL, Levator labii superioris proprii displaced
ventralwards toward inferior maxilla. It origin-
ally rested at end of dotted line from IOF ; IOF,
infra-orbital foramen ; NF, superior maxillary
division of the trifacial nerve.
OPENING OF THE GUTTURAL POUCHES. 53
II. OPERATIONS ON THE NECK.
n. OPENING OF THE GUTTURAL POUCHES.
Instruments. Razor, scissors, convex pointed and
straight probe pointed scalpels, artery forceps, tenacula
probe, trocar, curette, drainage tubing, suture and dressing
Technic. I. Viborg's method. The operation is possible
on the standing animal, but generally the patient must be
cast or placed on the operating table and secured in lateral
decubitis with the head extended. By extending the head
and compressing the jugular vein there is brought out the
triangle immediately behind the posterior border of the in-
ferior maxilla and below the parotid gland comprised be-
tween the posterior angle of the inferior maxilla, the terminal
tendon of the sterno-maxillaris muscle and the external
maxillary vein. In this so-called Viborg's triangle after the
removal of the hair and the disinfection of the skin which
is maintained stretched, make a 5 cm. long incision through
the skin and skin muscle immediately beneath the afore-
mentioned tendon and parallel to it. In case of pronounced
swelling in Viborg's triangle the operator must determine
the location for the incision by the position of the sterno-
maxillaris muscle. The skin and subcutem having been
incised to a sufficient extent, force a passage with the finger
or with probe pointed scissors closed or other blunt instru-
ment through the loose connective tissue on the median side
of the parotid gland, which area is free from large vessels
and nerves, to the guttural pouch and penetrate it at its
lowest point with the finger or trocar. In order to open
the empty guttural pouch it is desirable to grasp a portion
of its wall by means of forceps. Through the operative
OPENING OF THE GUTTURAL POUCHES (Hvo-
VERTEBROTOMY) ACCORDING TO VIBORG
Head and neck of recumbent horse viewed
from the side, sin, Stylo maxillaris muscle ; p,
parotid gland ; /, guttural pouch ; k, larynx ;
st, sterno-maxillaris muscle ; r, rectus capitus
anticus major muscle ; , external carotid artery ;
<?, external maxillary artery ; /, internal maxil-
lary artery ; v, external maxillary vein ; s,
probe ; a, wing of atlas.
OPENING OF THE GUTTURAL POUCHES. 57
wound a drainage tube can be introduced into the pouch,
and fixed in its position by sutures. The opening can be
enlarged in an anter-posterior direction to the extent of 5 to
A far more common operation in veterinary practice
than the opening of the guttural pouches, is the opening of
abscesses of the sub-parotid lymph glands, lying between the
inner face of the parotid and the external face of the guttural
pouch. The operation here used is the same as Viborg's
for the guttural pouch but does not penetrate that cavity
because the inner wall of the abscess has pushed the ex-
ternal wall of the pouch inward so that the former largely
occupies the usual location of the guttural pouch. The
dyspnoea generally prohibits casting the animal and neces-
sitates operating in the standing position. In some cases
the dyspnoea is so severe as to demand tracheotomy before
the opening of the abscess can be undertaken because the ex-
citement aggravates the difficult respiration to the point of
II. Chaberf s method. Secure the horse in the lateral re-
cumbent position, remove the hair and disinfect the skin
beneath the wing of the atlas. Make an incision about i
cm. in front of the lower half of the wing of the atlas and
parallel to it, about 6 cm. long extending through the skin
and skin muscle down to the parotid gland. The incision
is facilitated by rendering the skin tense with the left hand
and care is to be taken not to wound the auricular nerve
which passes directly along the atlas. Then draw backward
the posterior lip of the wound and separate with blunt in-
struments the posterior border of the parotid gland from the
atlas, to which it is bound by loose connective tissue, and
draw the gland forward with tenacula. At the bot-
tom of the opening thus formed there is seen the stylo-
maxillaris muscle, sm, Plate X, lying against the median
side of the parotid gland covered only by the aponeurosis of
the mastoido-humeralis muscle. With the handle of the
58 OPENING OF THE GUTTURAL POUCHES.
scalpel inclined toward the wing of the atlas penetrate in the
direction of their fibers the aponenrotic expansion of the
mastoido-humeralis muscle and the sterno maxillaris muscle.
The puncture is thus located between the ninth and tenth
nerves on one side and the internal carotid on the other.
Since the wall of the guttural pouch rests against the median
side of the digastricus muscle it is opened by this incision.
The operator inserts an index finger along the blade of the
knife at first and then withdrawing the instrument passes
the other index finger also in the penetrant wound and by
forcibly parting these dilates it. The abnormal contents are
then removed by means of forceps, curetting and irrigation.
In order to prevent adhesion of the wound lips in the firmly
stretched stylo-maxillaris muscle, introduce a strong drain-
age tube into the pouch and fix it to the external borders of
the wound by a suture.
III. Dieterich' 1 s method. This combines the operations
under I and II, with the difference that the superior opening
of the pouch is made immediately behind the stylo-maxillaris.
In order to accomplish this the cutaneous wound over the
wing of the atlas must be prolonged below it. After detach-
ing the posterior border of the parotid gland the operator
searches in the loose areolar tissue with the index finger of
the left hand for the vascular angle which is formed by the
occipital, internal carotid and external carotid arteries which
may be detected by pulsation the same is located at a depth
of somewhere from 8 to 10 cm. Place the volar surface of
the finger in the vascular angle and push a sharp scalpel
along the dorsal surface of the finger to the pouch which
here becomes opened on its posterior lateral surface.
This method has the advantage over Chabert's that for
the removal of hard contents (chondroid) the opening can
be readily dilated, even to such an extent that the entire
hand can be passed into the air sac and the opening of the
Kustachian tube be explored.
Instruments. Razor, scissors, convex scalpel, tenacula,
tenactilum and ligation forceps, trachea tube, and suture ma-
Technic. In the superior third of the neck, in the region
of the fourth to the sixth tracheal ring, shave and disinfect
the skin on the anterior surface of the neck to the extent of
10 cm. long by 5 cm. wide. The operation is best performed
upon the standing animal with the head extended In lat-
eral decubitis of the horse the operation is carried out with
some difficulty, and generally the operator fails to get the
incision on the median line. The operator stands before the
TRACHEOTOMY, s, sterno-thyro-hyoideus muscle ; /, trachea ;
sch, mucous membrane of the posterior wall of the trachea ;
/, interannular ligament.
right shoulder of the horse and the assistant opposite him.
On the shaved area the operator and his assistant takes up a
transverse fold of skin 3 to 4 cm. high, and divides the same
by an incision. The 6 to 8 cm. long wound in the skin then
6o TRA CHEO TOMY.
lies in the median line of the anterior face of the neck. Or
the incision may be made by rendering the skin tense along
the median line of the trachea with the left hand, then mak-
ing a drawing cut from above to below with the scalpel.
After the skin muscle is cut through, in order to avoid hem-
orrhage, separate the two sterno-thyro-hyoideus muscles by
means of tenacula along the median line in the white strip of
connective tissue. The opening into the trachea may be
made in a variety of ways. The quickest and most crude
method is to slit the trachea which has been laid bare from
above downwards through three or four tracheal rings, and
pressing the severed ends apart insert the tube through the
opening. Since the tracheal rings are incomplete, being
open on their dorsal surfaces, cutting through the ventral
portion divides each ring into two separate parts and their
being pushed apart, distorts them and tends to the causation
of chondritis and collapse of the trachea, a danger which in-
creases with the duration of time that the tube is maintained
in position. It is therefore most suitable for hurried opera-
tion in impending suffocation where the tube will probably
be needed for a short time only.
A second method of operation, illustrated in Fig. 2, con-
sists in making a transverse incision through the inter-annu-
lar ligament between the two last exposed tracheal rings the
length of the diameter of the tube to be inserted. Make
a perpendicular incision upward from each end of this at a
point i to 1.5 cm. from the median line through one or two
tracheal rings, according to the size of the tube. With
forceps or tenaculum grasp the segments of partially de-
tached cartilage and remove them by cutting through the
A third and to us preferable method is to insert a scalpel
transversely at about the lower third of the lowermost bared
tracheal ring and cutting outwards and upwards in a curved
line, pass through the first inter-annular ligament and con-
tinue the incision into the succeeding tracheal ring, curving
ARYTENECTOMY. 6 1
the incision upward and inward until the ring is cut about
y-$ in two, when the incision is turned downward to eventu-
ally reach the starting point, the isolated section of the tra-
chea being securely grasped by a pair of forceps before its
excision is completed. By this method no tracheal ring is
The trachea tube is to be removed and cleansed daily as
long as its use is necessary, and when finally removed the
wound should be left open and dressed antiseptically.
Object. The relief of roaring or laryngismus paralyticus.
Instruments. Razor, scissors, scalpel, razor shaped
knife with long handle, long curved sharp pointed scissors,
long curved uterine dressing forceps, double tenaculum for-
ceps, trachea tube, retractors, reflecting lamp, absorbent cot-
ton and dressing material.
Technic. Secure the animal in lateral recumbency
preferably upon the operating table and induce complete
anaesthesia. Shave and disinfect the skin over the laryngeal
region and also over the trachea at the usual point for
tracheotomy. Place the animal upon its back with the head
extended and remove the halter or other head gear. Per-
form tracheotomy in the manner described above, insert the
trachea tube and if necessary continue the administration of
chloroform through this by means of a funnel the small
end of which is inserted in the trachea tube while the
chloroform is dropped on a towel spread over the larger end.
The operator takes his place on the right side of the animal
and the assistant on the left. Make a longitudinal incision
through the skin and subcutem beginning at the anterior
part of the thyroid cartilage and extending backward on the
median line to the 3rd or 4th tracheal ring. Control the
cutaneous hemorrhage. Continue the incision through the
E, epiglottis ; TT, thyroid cartilage ; CC,
cricoid cartilage ; TRI, first tracheal ring ; V,
left vocal cord ; A, left arytenoid cartilage sur-
rounded by dotted line of incision ; CTL, crico-
: DIVERS/TV }
subjacent muscular tissue being careful to follow the median
line exactly until the crico-thyroidean ligament, CTL, Plate
XI, the cricoid cartilage C, and the first tracheal ring TRI,
are laid bare. Again control any hemorrhage. Plunge the
scalpel with its cutting edge directed backward through the
crico-thyroidean ligament on a level with the dotted line T
and extend this backward along the median line severing the
cricoid cartilage, C, and the first tracheal ring, TRI. Insert
the retractors and have the larynx held well open by as-
sistants. Illuminate the larynx by means of a reflecting
lamp as may be required. After controlling any hemorrhage
caused by the foregoing make an incision through the mucosa
and the intervening connective tissue between the two
arytenoid cartilages, A, beginning at the anterior part and
extending backward to the cricoid, thence turning upward
and laterally, incise the mucosa across the posterior end of the
arytenoid thence forward along its lateral border through
the vocal cord, V, and turning downward as the animal lies,
that is toward the dorsal part of the larynx, continue the
incision to the point of beginning. In making this incision
cut as closely as possible to the margin of the cartilage so
that a minimum amount of the mucous membrane will be
removed. Grasp the lateral border of the cartilage with
the long tenaculum forceps and with the razor-shaped knife
or the scissors separate the lateral and anterior portions of
it from the adjacent tissues keeping always immediately
against it in order to produce as clean a wound as possible
and to avoid injuring adjacent vessels from which hemor-
rhage would occur.
When the cartilage has been detached over the greater part
of its surface locate the crico-arytenoid articulation and dis-
articulate or cut through the arytenoid as close to the articu-
lation as possible with the razor-shaped knife or the scissors.
Remove all blood by means of pledgets of absorbent cotton
securely held in the long dressing forceps, or the clots may
66 INTRA-TRACHEAL IRRIGATION.
be pushed into the pharynx when they will generally be
swallowed. Carefully remove any cartilaginous remnants
or tissue shreds and control the hemorrhage from any
visible vessels. Dust the wounds thoroughly with iodoform
and tannin and if the capillary hemorrhage is great pack
the larynx with a single strip of iodoform gauze and secure
it by sutures through the margin of the skin wound. Re-
move this tampon after twelve to twenty-four hours. Wash
and disinfect the laryngeal wounds daily. Remove and
cleanse the trachea tube and wash the tracheal wound daily
and keep the trachea tube in position for five to seven days
according to conditions. After about eight days the re-
tractors should be placed in the laryngeal wound, the wound
dilated and the interior of the larynx examined with the
aid of a reflecting lamp and any unhealthy granulations or
other untoward conditions given proper attention.
14. INTRA-TRACHEAL IRRIGATION.
Objects. The washing of irritant or septic substances
from, and the disinfection of, the trachea and bronchi.
Instruments. Same as for tracheotomy, and a gravity
irrigating apparatus fitted with 3 m. of rubber tubing about
i cm. in diameter, 5 liters of .6 percent, soda bicarbonate or
chloride solution at a temperature of 37 to 39 C.
Technic. Operate on the standing animal. Perform
tracheotomy. Elevate the gravity apparatus containing the
irrigating fluid i to 2 m. above the patient, have the animal's
head slightly elevated, insert the free end of the rubber
tubing in the trachea tube and let the fluid flow into the
trachea in a moderate stream until it is filled and the animal
makes expulsive efforts, when the inflow is stopped and the
animal permitted to lower his head and expel the fluid, then
raise the head again and repeat until the fluid is expelled
clear. Repeat the operation according to requirement. In
cases of suppurative bronchitis, peroxide of hydrogen may
be added to the solution.
INTRA VENOUS INJECTION,
15. INTRAVENOUS INJECTION.
Instruments. Scissors, hypodermic syringe.
Technic. The operation is performed on the standing
animal on either jugular vein at about the juncture of the
upper and middle thirds of the neck ; to most operators the
right jugular is the more convenient. At the place desig-
nated the subscapulo-hyoideus muscle lies between the
jugular vein and the carotid artery. After clipping the hair,
the skin should be carefully disinfected. The vein lies in
FIG. 3. Intravenous Injection.
the jugular groove between the mastoido-humeralis and the
sterno-maxillaris muscles covered only by the skin and skin
muscle. Stand by the shoulder of the horse and compress
the jugular with the thumb as shown in Figure 3 or with the
second to the fourth fingers, in which case the ball of the
thumb rests on the mastoido-humeralis muscle, in a way that
the vein becomes filled above the point of compression in the
68 INTRA VENOUS INJECTION.
shorn area and stands out as a swollen cord. In the case of
fleshy necked horses this compression is more readily attained
if the head is somewhat elevated and extended by an
assistant. If the vein can not be made prominent in this
way the compression should be alternately applied and with-
drawn suddenly, the course of the vein then reveals itself by
a wave-like movement along the jugular groove. Just above
the point of compression the vein is the most fully distended
and firmly fixed. After testing the hypodermic needle to
see that it is open hold it between the second and third
fingers while the thumb covers its posterior opening and
thrust it through the skin, cutaneous muscle and jugular
wall, in the direction of the vein obliquely forwards and up-
wards i to 2 cm. deep, so that the point of the needle enters
the vessel at its most distended part. In this way it is easy
to prevent injury to the median wall of the vein. If the
vein has been properly punctured blood will flow from the
needle upon the removal of the thumb. If the vein is not
entered at the first attempt the needle should be partly with-
drawn and then pushed in again in a slightly different direc-
tion. The compression is then removed and the hypodermic
syringe in which no air is contained is connected and the
contents slowly discharged into the vein. In withdrawing
the needle be careful to press the skin firmly against the
underlying part. The omission of this precaution frequently
results in the formation of a subcutaneous hematome.
1 6. PHLEBOTOMY.
Instruments. Razor or scissors, fleams, lancet, phle-
botomy trocar, spring lancet, pins, suture material.
Technic. a. Phlebotomy ivith fleams may be performed
on either jugular vein. The operation is preferably carried
out on the standing animal, but is not difficult when the
patient is recumbent. The point of operation is at about the
boundary line between the upper and middle cervical regions,
because it is here that the subscapulo-hyoideus muscle which
separates the jugular vein from the carotid artery is most
voluminous and consequently affords the greatest protection
to the latter. At this point clip or shave and disinfect the
skin. Grasp the extended blade of the fleam at the joint
with the thumb and index finger of one hand, while the
third and fourth fingers compress the jugular vein at a point
far enough below the shaved part that the fleam blade rests
upon it. In fleshy-necked animals the course of the vein
may be clearly made out by causing its repeated distension
and relaxation. It is well to be careful that the point of the
fleam blade is not allowed to prick the skin prematurely and
render the animal restless, and that the fleam blade is held
perpendicular to the surface and parallel to the long axis of
the vein. The most elevated point of the vein should be
struck by the blade in such a way that the skin, subcutane-
ous muscle and jugular wall are penetrated parallel to the
long axis of the vessel. Drive the fleam blade into the vein
by a short, sharp blow with a light wooden stick. The ex-
tension on the fleam blade prevents its being driven too
deeply. The size of the blade to be used depends upon the
thickness of the skin and other tissues covering the vein. If
the vein is opened, dark red bloo^d escapes from the wound
in a large stream. If the operation does not succeed at the
first effort, one should select an undamaged portion of the
skin for a second attempt so that the opening into the vein
ma}' be direct and clean. When the vein is opened lay the
instrument aside, the compression of the vein being contin-
ued in order to prevent aspiration of air into it and also that
the lips of the wound shall not become overlapped by which
the escape of blood would be impeded or stopped. The flow
of blood may be favored by inducing masticatory movements
by the animal. The amount of blood withdrawn varies be-
tween 3 and 8 liters, according to the size of the animal and
the object to be attained. The wound may be closed by an
interrupted or a pinned suture. For the latter, relieve the
compression on the vein and grasp the lips of the skin wound
between the finger and thumb and stick the pin perpendicu-
larly through the middle of it a few mm. from its borders.
Apply a noose of silk ligature previously prepared over the
pin and close and tie the loop. In applying the pin and
loop, take care not to elevate the skin from the underlying
part, which tends to the production of a hematonie.
b. With the lancet the operation is preferably performed
on the right side of the neck. Compress the vein as illus-
trated in Fig. 3, and hold the lancet between the thumb and
index finger with the blade at right angles to the handle,
the thumb and finger being so placed on the blade that it
can barely penetrate the vein, and then push it in quickly
just in front of the compressing thumb through the skin,
subcutem and venous wall as deep as the fingers holding the
lancet will permit.
Hold the blade perpendicular to the long axis of the
vein, and avoid directing the point dorsalwards, which would
endanger the superior wall of the vessel or cause the
lancet to glide over the wall and not enter the vein. When
the lancet has entered the vein extend the wound somewhat
toward the head by flexing the hand dorsally. In cattle it
is necessary to compress tte vein by means of a cord tightly
LIGATION OF THE CAROTID ARTERY. 71
drawn around the neck, the operator taking the same posi-
tion as in the horse while an assistant holds the animal by
the horns or nose. Close the wound as in a.
Phlebotomy with the spring lancet is carried out in a sim-
ilar manner, the jugular being compressed in the same way,
and the lancet with the spring set placed over the vein in
such a way that the opening will be made in the same direc-
tion and manner as with the fleams. The lancet blade is
then released and penetrates the vein. The compression be-
low is continued as in other cases.
c. Phlebotomy with the trocar is performed in the same
manner as has been described for intravenous injection. So
long as the flow of blood continues the compression of the
vein must not be intermitted. The phlebotomy trocar should
be about 5 mm. in diameter.
17. LIGATION OF THE CAROTID ARTERY.
Objects. The control of hemorrhage from wounds or
the prevention of hemorrhage during the removal of tumors
or other operations in the parotid region.
Instruments. Scissors, scalpel, tenacula, aneurism
needle, mouse-toothed forceps, ligation forceps, suture
Technic. The operation is possible on the standing
animal with the aid of cocaine or other local anaesthetic but
it is preferable to confine the patient in lateral recumbency
The operation is made at the same point as for phlebotomy
and the same cutaneous wound, a, Plate XII, may be used
for this purpose. The incision should be at least 10 cm.
long extending through the skin, fleshy panniculus and
FIG. i. a, Ligation of the common
carotid artery ; b, CEsophagotomy.
FIG. 2. Ligation of the common
carotid artery. c, common carotid
artery ; /, jugular vein ; v, vagus nerve ;
s, sympathetic nerve ; r, recurrent
nerve ; p, cervical panniculous car-
nosus muscle ; m, sternomaxillaris
muscle ; st, levator humeri muscle.
FIG. 3. CEsophagotomy. c, com-
mon carotid artery ; /, jugular vein ;
o, o f , oesophagus ; s, sympathetic
nerve ; /, trachea ; st, mastoido hum-
eralis (lavator humeri) muscle.
LIGATION OF THE CAROTID ARTERY. 75
subscapulo-hyoideus muscles and then force a passage with
the fingers, with the cautious aid of the knife, to the trachea.
At the region of the neck indicated, the carotid passes along
the border between the lateral and dorsal surfaces of the
trachea, accompanied dorsally by the vagus and sympathetic
nerves and ventrally by the recurrent. In Figure 2, Plate XII
the vagus and sympathetic nerves, v and a, are pushed out
of their normal position and appear ventrally to the carotid.
Pass the index finger over and behind the carotid until the
trachea is reached, and encircling the inner and lower sides
of the artery, force a way through the surrounding areolar
tissue and draw the vessel out through the operation wound.
As a rule the carotid is still surrounded by the lamellar
fascia, which comes from the deep fascia of the neck in
which also the three above mentioned nerves are found.
These nerves must be carefully separated from the carotid
and must on no account be included in the ligature. Ligate
the carotid twice with an interval of about 2 cm. between
the two ligatures and divide the artery midway between the
two. The second ligature is necessary in order to prevent
hemorrhage from the distal end through collateral anasto-
moses and it is essential to sever the artery in order to avoid
its rupture by the stretching of the undivided carotid dur-
ing movements of the neck where the nutrition has been cut
off at the point of ligation. Provide drainage for the wound
and suture the muscle and skin.
Instruments. Razor, scissors, convex scalpel, straight
probe-pointed bistoury, tenacula, artery forceps, absorbent
cotton, suture material.
Technic. The operation can be carried out on the stand-
ing or the recumbent animal. At its origin the oesophagus
lies above the trachea, generally somewhat to the left of the
median line and gradually deviates farther to the left until
toward the lower cervical region it lies down along the left
side of the trachea.
The operation is performed at any point between the
pharynx and chest where the lodgment of a foreign body or
other condition may demand it. When the oesophagus is
empty the operation is best performed in the lower third of
the neck at b, Figure i, Plate XII.
An incision 10 cm. long through the skin and skin muscle
is made on the left side between the anterior border of the
mastoido-humeralis muscle and the jugular vein. With one
finger each of the left and right hand divide the loose con-
nective tissue down to the oesophagus, which lies between
the left scalenus muscle, trachea and the jugular vein.
Along the supero-external border of the trachea runs the
carotid, accompanied dorsally by the vagus and sympathetic
and ventrally by the recurrent nerves. The oesophagus feels
like a round muscle within which one can feel a firmer cord,
the mucous membrane, and has a pale red color. (Esopha-
gus and trachea are surrounded by the deep fascia of the
neck. Pass one finger around the oesophagus from behind,
draw it away from the trachea, force a passage through the
deep fascia of the neck and draw the oesophagus out through
the external wound. After making an incision through the
muscle and mucous membrane introduce a probe pointed
scalpel or a scissors blade into the lumen of the oesophagus
and split its wall. The mucous membrane is white and lies
in thick longitudinal folds. When there is a foreign body
in the oesophagus the operation is performed at the point
where it is lodged in the manner described and the incision
should be made only large enough to permit its removal. In
diverticuli of the oesophagus an elliptical piece of the mucous
membrane which has been overstretched is cut out. The
cesophageal wound is closed by a laminated suture, that is,
the mucous membrane is united by means of an intestinal
suture and the muscular wall closed over this. The skin
and muscular wound may either be left open or closed with
the Bayer suture and bandaged with a drainage tube in the
lower angle of the wound.
78 PUNCTURE OF THE CHEST.
III. OPERATIONS ON THE TRUNK AND GENITAL
19. PUNCTURE OF THE CHEST.
Objects. The relief of hydrothorax or pyothorax.
Instruments. Razor, scissors, trocar, i m. of rubber
tubing of the same size as the trocar, vessel for receiving
the escaping fluid, dressing material.
Technic. Operate upon the standing animal, the point
of operation being the seventh intercostal space on the left
side, and the sixth on the right. Dogs may be laid upon
Puncture of the chest ; puncture of the intestine.
the table. The ribs are enumerated from behind forward,
counting eighteen for the horse and fourteen for the dog.
Clip or shave the designated intercostal area immediately
above the thoracic vein. Grasp the trocar firmly with the
PUNCTURE OF THE INTESTINES. 79
thumb and index finger of one hand at a distance from the
point which will permit the canula to enter the chest. Af-
ter the skin over the seat of operation has been drawn aside
by the hand place the trocar at the anterior border of the
rib with the point inclined slightly forward and with a sharp
blow with the palm of the other hand drive the instrument
through the skin, skin muscle, intercostal muscles, internal
thoracic fascia and pleura into the pleural sac. When the
resistance ceases, the thoracic cavity has been entered. Re-
move the stilette and permit the pus, lymph, or other fluid
to escape. This escape is at first continuous, but later be-
comes rythmic, synchronous with respiration. The inter-
mission of the outflow during inspiration permits air to enter
the pleural cavity unless precautions are taken against it ;
this is most readily obviated by slipping one end of the rub-
ber tubing over the exposed end of the canula and placing
the other extremity in the receptacle for the fluid where it
will be submerged. This will not only prevent aspiration of
air into the chest but will act as a syphon to aid in the aspi-
ration of the fluid from the pleural cavity. In the absence
of the tubing the entrance of air may be avoided by closing
the canula with the finger after each expiration.
20 PUNCTURE OF THE INTESTINES
FIGS. 4, 5.
Object. The relief of intestinal tympany.
Instruments. Razor, scissors, trocar, disinfectants.
Technic. Puncture of the intestine is preferably per-
formed on the standing horse but may be carried out on the
recumbent animal. The point of operation is in the right
flank about equi-distant from the last rib, the extremities of
the transverse processes of the lumbar vertebrae and the ex-
ternal angle of the ilium in the standing horse, at the upper-
most point of the abdomen in the recumbent animal, that is,
8o PUNCTURE OF THE INTESTINES.
at the most prominent part of the distension. After the
skin at this place has been clipped or shaved and disinfected
grasp the trocar with the index finger and the thumb of the
left hand and holding the instrument perpendicular to the
skin, give it a firm quick blow with the palm of the right
hand and drive it through the abdominal walls into the
intestine. With a properly constructed trocar of the dimen-
sions suggested in Figure 5 no preliminary puncture with
the lancet is required or advisable. The cutting end of the
stilette should be very long, tapering and sharp so that it
will cut as freely as the lancet. By performing the opera-
tion as directed the trocar ordinarily punctures the caecum.
Intestine trocar with sheath. Outside diameter of canula 3 mm ,
length of canula, 16 cm.
Withdraw the stilette and permit the gas to escape through
the canula. The canula may become occluded by particles
of ingesta entering it and these should be removed by rein-
serting the stilette. The intestine first punctured may
collapse and the flow of gas cease while the tympany con-
tinues in other parts ; this may be overcome by reintroducing
the stilette and pushing the trocar through the distal wall of
the bowel and into the next section of intestine beyond.
If this does not succeed the trocar may be withdrawn and
reinserted in a neighboring area or if need be on the opposite
side of the .animal. In withdrawing the canula replace the
stilette and press the skin against the abdominal with the
thumb and finger of one hand while the trocar is drawn out
with the other. This tends to prevent particles of ingesta
SUBCUTANEOUS CAUDAL MYOTOMY. 81
from following the canula out of the intestine and becoming
lodged at some point in the track of the wound to set
up inflammatory processes there. Before introduction, the
trocar should always be rendered sterile but should not bear
irritant antiseptics, which becoming lodged in the wound
tend to irritate the tissues and produce abcesses. Puncture
of the intestine is so often extremely urgent that deliberate
aseptic precautions are not always practicable and trocariza-
tion only too frequently results in abscesses in the abdominal
wall. Its prevention must depend chiefly upon the disinfec-
tion of the skin and instrument. It becomes important to
use an instrument which is clean in advance. If the one
shown in fig. 5 is well disinfected after using and the sheath
is filled with alcohol before it is screwed on, the instrument
will remain sterile until it is again unsheathed and then the
alcohol will quickly evaporate and leave it aseptic.
21. SUBCUTANEOUS CAUDAL MYOTOMY.
Object. The correction of curved tail.
Instruments. Sharp straight tenotome, bandage.
Technic. The point or points of curvature and their
extent are to be carefully noted by having the animal trotted
away from the operator. The curvature is generally due to
unequal development of the two levator or extensor muscles
Fig. 6 e, though quite rarely the depressors, /, may be
implicated. Confine the animal in stocks, or in default of
these, control by means of a twitch and sideline. Cleanse
and disinfect the tail and have it sharpty bent by an assist-
ant in the opposite direction to the curvature. Locate the
longitudinal furrow between the levator and depressor mus-
cles on the convex side and at the lower margin of the
levator and just above v, Fig. 6, insert the tenotome at the
SUBCUTANEOUS CAUDAL MYOTOMY.
most prominent part of curvation, the incision being parallel
with the muscular fibers, and push the instrument entirely
through the muscle to the vertebra, then turning the cutting
edge upwards, at the same time advancing the point of the
tenotome toward the median line, sever the entire muscle.
The superior lateral caudal artery, s, Fig. 6, bleeds profusely
if severed, and wounding of it may usually be avoided by
withdrawing the tenotome a trifle in passing that point.
Wounding the skin over the muscular incision is avoided by
Transverse section of the tail, n, caudal vertebra ; c, sacro-
coccygeus lateralis muscle ; , sacro-coccygeus superior ; f,
depressor longus and brevis muscles (sacro-coccygeus infer-
ior) ; z, intertransversales muscles ; a, coccygeal artery ; s, su-
pero-lateral coccygeal artery ; /, infero-lateral coccygeal ar-
tery ; v, caudal veins (dorsal, ventral, lateral) ; sch, caudal
fascia ; h, skin.
placing the thumb of the left hand over the line of incision
so the knife will be recognized as soon as the muscle and
caudal fascia are -cut through. Remove the knife in the same
manner as introduced. Release the horse and have him
trotted agai n . If the operation is sufficient the tail should curve
in about the same degree as before, but in the opposite direc-
CAUDAL MYECTOMY. 83
tion. If this has not been attained examine carefully and
sever any remaining bundles of muscle, and this not sufficing
repeat the operation as before at another point 5 or 6 cm.
above or below the first, severing the muscle again. Or if
the depressor appears implicated, sever it in a similar manner.
In extreme cases the entire lateral half of muscles, tendons
and aponeurosis may be severed. Apply an antiseptic pad
to the wound and retain it by a moderately firm bandage,
which serves at once as an occlusive dressing and effective
hemostatic. Remove the bandage after 24 hours.
22. CAUDAL MYECTOMY.
FIG. 6 and PLATE XIII.
Objects. For the prevention of the gripping of the reins
by the tail.
Instruments. Elastic bandage, elastic ligature, straight
bistoury, tenacula, absorbent cotton, bandages, disinfecting
Technic. Confine the animal in lateral decubitis or in
stocks, cleanse and disinfect the tail, apply the elastic bandage
tightly to it beginning at the apex and continuing to its
base and then apply the elastic ligature as close as possible
to the root of the tail. Have an assistant hold the tail up-
wards, i.e., dorsalwards, and tightly stretched. Make an
incision 15 to 20 cm. long, over the middle of the inferior
surface of each depressor longus muscle, beginning close
against the elastic ligature and extending toward the apex,
severing at once the skin and caudal fascia down to the
muscle. Let an assistant retract the lips of the incision with
tenacula while the operator dissects the depressor longus
muscle, DC, Plate XIII, from the adjacent tissues at either
side, sever it by a transverse incision close against the liga-
CAUDAI, MYECTOMY To PREVENT GRIPPING OF
DC, Depressor coccygeus longus muscle ; T,
CAUDAL MYECTOMY. 87
tare and dissect away the entire muscle down to the lower
end of the wound and there excise it. The small depressor
brevis, lying on the median side of the longus need not be
removed, thus preserving a limited depressor power. Re-
peat the operation on the opposite depressor. Make two
elongated tampons of absorbent cotton, of the size and form
of the muscles removed, saturate these in 1-1000 sublimate
solution, insert neatly in the wounds and apply a moderately
firm bandage as closely as possible to the elastic ligature.
Remove the ligature, upon which hemorrhage ensues, which
is to be controlled by the application of a second bandage
extending higher up on the tail over the previous location
of the elastic ligature. Remove the bandage in 24 hours,
wash the parts and saturate the tampons again with i-iooo
sublimate solution and apply a fresh bandage, allow it to re-
main for another 24 hours, remove the bandage and tampons
and treat as an open wound. Care should be taken to not
apply the bandage too tightly or leave it in place for more
than 24 hours, since otherwise necrosis of the tail is liable
to occur and necessitate amputation.
AMPUTATION OF THE TAIL.
23. AMPUTATION OF THE TAIL.
FIG. 6 AND 7.
Objects. Malignant or incurable diseases of the tail.
Instruments. Docking shears, ring cautery iron, dock-
ing chisel, mallet, a block of wood, suture material.
Technic. I. Docking with the shears. Operate on the
standing animal secured in the stocks or with the aid of the
twitch and one fore foot held up or the side line applied to
Amputation of the tail. /, ligature for binding the hair of
the tail upwards.
a hind foot. The point of amputation is determined by the
location of the disease. At this point the hair is parted
around the organ, turned upwards and bandaged to the root of
the tail with a compression bandage which at the same time
serves to retain the hair out of the operator's way and to
make the operation bloodless. Beneath the part clip the
AMPUTATION OF THE TAIL. 89
hair away for a space of 3 to 4 cm. around the tail, have an
assistant hold it horizontally, stand at the side, behind the
left leg and apply the docking shears in such a way that the
clipped portion of the dock rests in the semi-circular depres-
sion in the shears. By quick and powerful closing of the
handles of the docking shears cut, if possible, between two
caudal vertebrae at one stroke through the entire organ.
Grasp the stump of the tail with the left hand and press the
red-hot ring iron against the parts between the skin and
vertebrae for from ten to twenty seconds in order to stop the
hemorrhage so that a dry and firm necrotic scab covers the
wound surface. In cattle and dogs the tail is amputated in
a similar manner between two vertebrae ; a straight knife
will answer for operating instrument. Hemorrhage is like-
wise most promptly controlled by cautery. legating the
arteries and applying a bandage is more aesthetic.
II. Amputation with the chisel. Prepare for the operation
in the same manner as in I. Have an assistant hold a block
of wood against the ventral surface of the tail at the point
for amputation. Place the chisel on the dorsal surface of
the tail at the point desired, with its convex side directed
towards the base of the organ, and with a vigorous blow
with the mallet drive the chisel through it against the
wooden block held below. In cases of extensive melanosis
the chisel may be far too narrow to cut off the entire organ
at one blow in which case the instrument is still to be placed
centrally and driven through the caudal vertebrae and the
lateral parts may then be severed with a scalpel. There is
now left a triangular wound, the vertebra constituting the
apex. Ligate any visible vessels and draw the lateral flaps
together on the median line by means of strong silk sutures
passed through the two flaps at their thickest parts and
unite the edges of the wound by frequent interrupted sutures.
Apply antiseptics and remove the bandage. This operation
is preferable in point of blemish and sensibility of the stump
90 URETHROTOMY. LITHOTOMY.
24. URETHROTOMY. LITHOTOMY.
FIG. 8, 9.
Objects. For the removal of calculi from the bladder or
urethra or performing other operations on these parts.
Instruments. Catheter, convex scalpel, scissors, artery
and compression forceps, tenacula, litliotome, lithotomy
forceps, lithotrite, absorbent cotton, drainage tube, suture
Technic. Urethrotomy may be performed on horses in
a standing position, the hind feet being secured with hobbles.
It is best, however, to operate under anaesthesia with the
patient in lateral or dorsal recumbency, either on the operat-
ing table or cast, being careful to secure as gently as possible,
having first emptied the bladder if practicable, since rupture
of an f overdistended viscus may readily occur during violent
struggles by the animal.
The point of operation will depend upon the location of
the calculus or other obstacle. If it is found in the pelvic
portion of the uiethra or in the bladder, the operation is
made at the ischial notch, Fig. 8. First the penis is drawn
out from the prepuce and the catheter introduced into the
urethra and pushed upward until it has passed the ischial
notch. After disinfection of the skin, render it tense and
make a 5 cm. long incision on the median line at the ischial
arch through the skin, bulbo-cavernosus muscle, spongy
portion of the urethra, and the urethral mucous membrane
down to the catheter, Fig. 9, k. In order to prevent infiltra-
tion of urine after the operation, special care is to be taken
to make the lower end of the wound slanting in such a
manner that the inner margin is higher than the outer.
After the catheter has been drawn back away from the
ischial arch, introduce the lithotomy forceps into the urethra
or bladder, grasp the stone and draw it outward in its natural
direction. The grasping of the stone by the forceps is
materially aided by means of the left hand introduced into
URETHROTOMY. LITHOTOMY. 91
the rectum. One must avoid grasping, along with the stone,
the mucous membrane of the bladder. Partial rilling of the
bladder with a tepid aseptic solution will aid in grasping the
calculus and in avoiding the implication of the bladder walls.
By careful rotary movement and pushing the forceps back-
ward and forward the operator can determine before the ex-
traction of the stone if the forceps can be withdrawn easily
and without much resistance through the neck of the
FIG. 8. Urethrotomy at the ischial notch.
bladder. If the stone is so large that it can not pass the
neck of the bladder lithotripsy must be performed. This
operation requires time and patience, since as a rule it is not
possible to encompass the entire calculus with the forceps.
That is, the narrowness of the neck of the bladder prevents
the sufficiently wide opening of the forceps. The stone con-
sequently must be gradually broken off at its periphery and
the individual pieces of calculus removed. The character of
the surface of the stone has an evident bearing upon the
practicability of lithotripsy.
When this operation is impossible, the operative dilation
of the neck of the bladder with the lithotome can be under-
taken as a last resort. Introduce the instrument closed into
the bladder, it is then opened and the neck of the bladder
divided upward and laterally as the instrument is withdrawn.
In order to prevent injury to the rectum it should be emptied
before the operation is undertaken. After the removal of
the stone, push the catheter again over the ischial arch and
unite the lips of the wound in the urethral mucous mem-
FiG. 9. Urethrotomy (life size), h, skin ; a, retractor penis muscle ;
b, bulbo-cavernous muscle ; c, spongy urethra ; u, urethra ; k,
brane b}^ means of intestinal sutures. Flush the bladder or
urethra by means of a warm 3 per cent, boric acid solution
injected through the catheter and then withdraw the latter.
Finally, suture the skin wound and insert a drainage tube
or iodoform gauze in the lower angle of the wound. The
whole wound may be left entirely open and be dressed daily
with antiseptics. For student practice, on an anaesthetized
horse, introduce a stone into the bladder through the ure-
thral wound and practice grasping and removing it with the
AMPUTATION OF THE PENIS. 93
25. AMPUTATION OF THE PENIS.
Instruments. Scalpel, elastic ligature, strong silk
thread, strong piece of tape i m. long, artery and compres-
Technic. The operation is carried out on the recumbent
animal under complete anaesthesia, the upper hind foot be-
ing drawn forward or otherwise so fixed as to not obstruct
the field of operation. The point of operation is determined
by the character of the disease and the object to be attained.
It may be made at any point from the glans penis to the
attachment of the corpus cavernosum to the ischium. If
possible amputate in front of the preputial ring. After the
penis is drawn out, and the preputial region is carefully
cleansed with brush and soap, an assistant grasps it just be-
hind the preputial ring with the hand and holds it firmly.
A temporary elastic ligature, p, is then applied in front of the
hand around the penis, or the piece of tape is looped around
it above the hand and it is made to serve both as a tour-
niquet and as a means for holding the penis, and it is then
excised by a circular incision about 5 cm. in front of the
elastic ligature, or immediately in front of the preputial
ring. The dorsal blood vessels of the penis are ligated sep-
arately. The urethra, u, lying on the ventral side of the
penis, covered by the corpus cavernosum of the urethra, is
dissected out of the urethral groove for a distance of about
2 cm., its dorsal wall slit and the mucous membrane sutured,
spread out fan-like to the surrounding tissues. The urethra
can also be slit dorsally and ventrally and the halves sutured
to the left and the right. A silk ligature, //, is applied to the
corpus cavernosum, c, just above the point of excision of the
penis and the elastic ligature then removed. After a few
days the silk ligature is also removed.
1 1 i?
O SI P
VAGINAL OVARIOTOMY IN THE MARE. 97
26. VAGINAL OVARIOTOMY IN THE MARE.
FlGS. 10, II AND Pl,ATE XV.
Objects. The alleviation of vice when related to ovarian
irritation or disease.
Instruments. Colin's scalpel, ratchet ecraseur, 55 cm.
Technic. The vnlvo-vaginal canal of the mare is unique
in its physiological behavior. Under venereal excitement or
the introduction of the operator's hand or of tepid water the
organ has the power of " ballooning " or dilating to a degree
not seen so far as we know in other animals ; the walls be-
come erected, hard, and stand apart from each other, filling
the pelvic cavit}^, the vaginal walls resting firmly against the
FIG. 10. Special spraying ecraser, 55 cm. long.
FIG. ii. Colin's scalpel.
pelvic bones at every part except at the points where the blad-
der and rectum intervene and these organs are pressed out flat
and occupy a minimum space. In the quiescent state the
vaginal walls are in contact and from the perinaeum forward
to within about locm. of the uterine os, the vulva and vagina
are connected above with the rectum by the pelvic connec-
tive tissue, while anterior to this point the vagina is covered
by peritoneum, and it is in this area that the incision needs
VAGINAL OVARIOTOMY IN THE MARE.
Diagrammatic sagittal section through the
"ballooned " vagina. V, vagina ; OA, operative
area ; I, point of incision ; U, uterus ; R, rectum ;
A, aorta with dotted lines posteriorly to indi-
cate location of the iliacs.
VAGINAL OVARIOTOMY IN THE MARE. 101
be made in the operation. The ballooning of the vagina
profoundly alters the relation of this operative area, OA,
Plate XV, and changes it from the horizontal in the quies-
cent organ to the perpendicular in the ballooned conditioned.
These variations permit two methods of operation, on the
quiescent organ where the incision must be upwards, and on
the " ballooned " or erected, where it must be directed for-
wards. We follow the latter, because since the "balloon-
ing " can always be induced, the operation can thus be made
uniform in all cases, and we believe it safer and more readily
performed. The operation should always be performed on
the standing animal, and stocks constitute the proper form
of restraint. It can be performed under other means of re-
straint, even in the recumbent animal, but it is inadvisable
and greatly increases the difficulties and dangers. Secure
in the stocks with the head elevated, a rope over the back to
prevent rearing, straps beneath the body to prevent lying
down, straps or ropes before and behind the animal to pre-
vent backward and forward movements, all four feet pinioned
to the floor, and the tail firmly secured and stretched to a
With soap, water and brush cleanse the tail, perineum and
vulva thoroughly, being especially careful to remove all
detachable masses of sebum ; 50 per cent, alcohol may be
used sparingly to aid in removing this. Too free a use of
alcohol excoriates the delicate skin. Cleanse the clitoris
carefully. Follow the washing with a free application of
1:1000 aqueous sublimate solution to the external parts and
for a short distance inside the vtilvar lips and to the clitoris.
Do not introduce disinfectants into the healthy vagina nor
deeply into the vulva as it will cause severe straining during
and subsequent to the operation and by injuring the vulvo-
vaginal mucosa favor subsequent infection of the vaginal
wound. Wash away the sublimate solution with a tepid .6
per cent, soda bicarbonate solution, and fill the vulvo-vaginal
102 VAGINAL OVARIOTOMY IN THE MARE.
canal with the same. After thorough disinfection of the
hands and arms remove the disinfectants by washing in
sterile soda solution, which at the same time renders the
hand unctuous and readily introduced through the vulva.
Armed with the guarded sterilized scalpel, Fig. 10, intro-
duce the right hand into the vagina promptly and when it is
well "ballooned" unsheath the knife and placing it just
above'the os uteri at I, Plate XV, parallel to the long axis
of the uterus and a few mm. to the right or left of the median
line, in order to avoid a loose fold of mucous membrane gen-
erally existing directly on the median line, the blade being
held vertical, that is the cutting surface parallel to the longi-
tudinal muscular fibers of the vagina, and guarding the pos-
sible extent of its introduction with the thumb and fingers,
push it directly forward in a straight line with a quick thrust
through vaginal mucosa, the muscular walls and the peri-
toneum, until the disappearance of resistance indicates that
the peritoneum has been penetrated. This is the most criti-
cal step in the operation.
If the hand is introduced immediately after the injection
of the sterile saline solution the vagina will generally be
found " ballooned " or will quickly become inflated under
movements of the hand. If the solution is thrown out the
vagina may collapse and closely invest the hand, in which
case more soda solution should be injected when it will again
dilate. If the hand is introduced without the knife, with-
drawn and then introduced with the knife it will be frequently
found that the vagina has collapsed and needs a second fill-
ing with the fluid. Patience until dilation is accomplished
and promptness to act when attained are prime requisites
to success. The knife should be pushed through the vagina
quickly making a clean wound the width of the knife blade,
when the latter is to be withdrawn and laid aside. It should
be remembered that in this " ballooned " state, the anterior
wall of the vagina is but 2 or 3 mm. thick and easily pene-
trated. Introduce the hand again, push one finger into
VAGINAL OVARIOTOMY IN THE MARE. 103
incision, then a second and third finger, and eventually
holding all the fingers in the form of a cone push the entire
hand into the peritoneal cavity. Immediately below the in-
cision and continuous with the tissues involved in the wound
lies the uterus with a transverse diameter of 4 to 6 cm.
With the palm of the hand downwards, trace the uterus,
U, Plate XV, forward a distance of 15 to 1 8 cm., where it
ends abruptly in two cornua of about the same size as the
uterus, which are given off horizontally at almost right
angles. Trace these to the right and left for a distance of
14 or 15 cm., where they end obtusely, and 3 or 4 cm. be-
yond this in a direct line, resting upon the anterior border
of the broad ligament is the dense oval ovary varying in size
from 2.5 to 7 cm. in diameter. Withdrawing the hand,
carry the ecraseur enclosed within it through the vaginal
wound to the region of the ovary, release the ecraseur and
retrace the parts if necessary, and locating the ovary drop
the chain over it from above and either grasp it with the
fingers through the chain from above and draw it into the
loop or passing one or two fingers around beneath the ovary
push it up through the loop to be grasped by the thumb and
index finger above. The chain loop should be of barely
sufficient size to admit of the easy passage of the ovary.
Holding the ovary with one hand tighten the chain quickly
with the other, examine to make sure that a loop of intes-
tine is not caught, draw the ovary well through and get a
large portion of the oviduct, and cut off promptly, holding
to the ovary until carried out through the vulva. Remove
the other ovary in the same way. Generally it is most con-
venient to remove the left ovary with right hand and vice-
versa, but both may be removed with either hand. Wash
away any blood from external parts, apply sublimate solu-
tion freely to the vulva, perineum and tail. Keep the pa-
tient quiet for five or six days, and feed lightly on a laxative
104 VAGINAL OVARIOTOMY IN THE MARE.
Wounding of the rectum is scarcely possible if care is
taken not to attempt the incision until the vagina is well
" ballooned," and then making the stab wound directly for-
ward. If made upwards when the organ is so erected the
accident is highly probable, and with the undilated vagina
where it is necessary to cut upwards the danger is ever pres-
ent. Its prevention demands that the operator await the
complete "ballooning" and then make his incision as
directed. If the wound in the rectum passes through the
pelvic connective tissue behind the peritoneum it is of little
consequence, but the operation should be abandoned ; if
the bowel is opened into the peritoneal cavity the accident
"Wounding of the iliac arteries, which produces prompt
death from hemorrhage, results from the incision being made
upwards instead of forwards either when the vagina is " bal-
looned" or collapsed. It is most likely to occur with timid
operators who become nervous, especially when the vagina
does not "balloon" promptly or the mare is not well
secured. The accident is wholly unnecessary if the opera-
tor will await the "ballooning" and favor it if need be by
repeated injections of tepid soda solution. When it has oc-
curred it is generally beyond remedy.
Wounding of the uterus may occur when the incision
is directed downward and may greatly embarrass the opera-
tor and confuse him by passing the hand through the incis-
ion into the uterine cavity. It is to be avoided by carefully
directing the incision straight forwards ; when the accident
occurs it is of little consequence beyond the embarrassment
and may be overcome by again dilating the vagina with
fresh injections of the soda solution and making a new incis-
ion, or if preferred the first incision may be corrected by
placing an index finger against the peritoneum at the upper
part of the wound, and with a sudden and vigorous thrust
VAGINAL OVARIOTOMY IN THE MARE. 105
break through the peritoneum into the cavity. Great care
must be exercised to make the thrust quickly and vigorously
or the peritoneum will separate from the adjoining tissues
and a large cavity be formed between the peritoneal and
muscular walls of the vagina with a large area of yielding
membrane which it is difficult to penetrate. It is not very
safe in such cases to attempt continuing the incomplete in-
cision with the scalpel, as it is very yielding and pushes
against neighboring organs before it is penetrated and affords
no signal to the hand by cessation of resistance when it has
Incomplete penetration of the vaginal wall is liable to
occur if the scalpel is dull or the vagina incompletely " bal-
looned " and flaccid, or if the operator is unduly timid. It
is best prevented by avoiding the cause as related, and once
it has occurred it is generally best to again " balloon " the
organ and make a new incision either to the right or left of
the first. It may be overcome also by thrusting the index
finger through the peritoneum as described in the preceding
The mistaking of a ball of feces for the ovary has oc-
curred to inexperienced operators and the fatal error of re-
moving the portion of the rectum surrounding the fecal pellet
committed. The blunder is uncalled for ; the fecal ball is
movable in the bowel, the intestine is far more massive than
the broad ligament, and the ovary is to be definitely identi-
fied by its being lodged in the broad ligament just beyond
the end of the oviduct, which is continuous with the uterus
and coruna. If, therefore, one traces the uterus forward to
the coruna, thence along these to the oviducts, and thence
along the border of the broad ligament to the ovary, as above
directed, the error will not occur.
The incision may readily be made too low and pass
beneath the broad ligament. It is to be avoided by being
careful to keep close to the median line and above the os uteri.
io6 VAGINAL OVARIOTOMY IN THE MARE.
If it occurs the operation may be completed from beneath
without very great difficulty only that the ovary now lies
above the hand and must be drawn down from on top the
broad ligament in order to fix the ecraseur upon it.
Infection constitutes always the most serious danger and
is to be avoided by proper securing of the animal, by the
avoidance of irritant antiseptics in the vagina, by rigid anti-
sepsis at every stage, and by carrying out the mechanical
parts of the operation deliberately, vigorously and neatly.
If infection should occur it will generally take the form of
pelvic cellulitis with abscesses and rectal stricture. Enemas
of a normal salt or soda solution affords the surest relief of
the stricture and impaction in front of it. The abscesses
must be watched and opened early into the vagina or rec-
tum, and the case treated internally and locally according to
general surgical principles.
VAGINAL OVARIOTOMY IN THE COW, 107
27. VAGINAL OVARIOTOMY IN THE COW.
Objects. Increasing the fat or milk-producing qualities
and the cure of nymphomania.
Instruments. Colin's scalpel, vaginal dilator, Miles'
Technic. Confine the cow in the standing position in
the stocks, securing the head firmly and passing two boards
beneath the abdomen and sternum to prevent lying down,
and a rope over the middle of the back to prevent arching
of the spinal column and straining.
Wash and disinfect the tail and the perinaeum and flush out
the vagina with a .5 per cent, solution of carbolic acid or
lysol at a temperature of about 100 F. Insert the vaginal
dilator with one hand and push the prolongation at the an-
terior end into the os uteri. With the other hand elevate
the handle of the dilator and depress and push forward the
uterus, thus rendering the roof of the vagina tense and push-
ing it downward away from the rectum. Carry the scalpel
into the vagina with the right hand and resting it in the
oval of the dilator make an incision through the roof of the
vagina, beginning at a point 8 to 10 cm. posterior to the
os uteri and extending backward on the median line for a
distance of 2 or 3 cm. Be careful to make the incision en-
tirely through the mucosa, muscle and peritoneum at the
first cut, since any failure to complete the incision tends to
cause the peritoneum to separate from the muscular coat
and form a pocket between them, while the peritoneum be-
ing very elastic renders it difficult to complete the incision.
Introduce two fingers through the incision, and reaching
over the side of the vagina to the right or the left, the right
or left ovary respectively is recognized lying immediately
against the vagina somewhat below it, just at the anterior
border of the pubis, in a mass consisting of the cord-like
Fallopian tube and the fimbrise of its pavilion. The ovary
108 VAGINAL OVARIOTOMY IN THE COW.
may be distinguished as a firm oval mass 2 to 40111. in length
and i to 2 cm. in its lesser diameter attached to the broad
ligament. If not promptly recognized by the sense of touch,
trace the vagina and uterus with the fingers forwards from
the vaginal incision to the cornua and follow them as they
bend upward and then backward to the Fallopian tubes, and
trace each of them until the ovary is reached, where it is at-
tached to the broad ligament, just beyond the fimbriated end.
Grasp the ovary between the index and middle fingers and
draw it through the incision into the vagina. Introduce the
scissors with the other hand, and when the ovary is reached
open them barely sufficient to admit the broad ligament
between the blades and cut away the ovary along with a
considerable amount of the broad ligament. It is essential
that plenty of the broad ligament and Fallopian tube be
removed with the ovary in order to insure the entire removal
of the latter, because the accidental leaving of the smallest
particle of ovarian tissue will cause a development of these
into abnormally large Graafian follicles, and will tend to in-
crease rather than decrease nymphomania. Should the ani-
mal be pregnant the ovary on the gravid side is dragged
downward and forward out of reach of the operator's fingers,
and if it is desired to complete the operation it may be neces-
sary to enlarge the vaginal wound and introduce the entire
hand, when the ovary can be reached and removed. No
after care is generally necessary.
The Dangers are similar to those of the mare. The iliacs
may be wounded in the same manner as in the mare and is
preventable by being careful to push the vaginal roof wel
downwards away from the rectum and pelvic roof.
A new danger appears in the presence of the rumen, the
supero-posterior portion of which projects into the pelvic
cavity when filled with food and if the cut is directed for-
wards a stab wound readily penetrates its walls with fatal re-
sults. Make the cut upwards and backwards.
OVARIOTOMY IN THE COW. 109
28. OVARIOTOMY IN THE COW BY THE FLANK.
Instruments. Clipping shears, convex scalpel, spaying
shears, heavy needle and thread.
Uses. Same as the preceding, applicable to heifers or to
cows when the vulva is too small to admit the operator's
hand or in case of diseased vagina or uterus.
The animal may be secured as in the preceding or con-
fined in lateral recumbency with the hind legs extended
backward and the anterior limbs forward. To accomplish
this loop a rope about the two fore feet, another about the
two hind feet, and drawing upon these, cast the animal and
secure it in recumbency with the legs extended and body
stretched by fastening the ropes to two strong posts about
8 to 10 m. apart. The operation may be performed in either
Clip the hair from the upper part of the flank, disinfect
an area 15 to 25 cm. square and make an incision about 12
cm. long beginning at a point equi-distant from the anterior
tuberosity of the ilium, the ends of the transverse processes
of the lumbar vertebrae and the last rib and extend it down-
ward perpendicularly severing the skin and subcutaneous
muscle. Divide the external oblique muscle in the direction
of its fibres by means of the scalpel handle or the fingers
and repeat the process upon the internal oblique muscle after
which puncture the peritoneum either with the scalpel or by
means of a sudden thrust with the index finger. Force one
hand through the opening into the peritoneal cavity and
search for the ovaries at the same point and by the same
method as in the preceding operation, that is, locate the
uterus within the pelvic cavity, between the rectum and
bladder and trace the former and thence the cornu, oviduct
and broad ligament to the ovary. The uppermost ovary
can be drawn out through the wound and cut off with the
scissors ; the lower one must be held with one hand and the
no OVA RIO TOM Y IN THE BITCH.
scissors introduced closed along the arm and when the ovary
is reached, opened barely sufficient to pass over the broad
ligament and clip it off. The beginner must always remem-
ber that the positive means for identifying the ovaries is by
tracing the uterus from the vagina along its cornua to the
Fallopian tube and thence to the ovary in the broad liga-
ment. Cleanse the wound and close the skin incision with
29. OVARIOTOMY IN THE BITCH BY THE FLANK.
Instruments. Spaying knife, suture material.
Technic. Confine the animal in lateral recumbency,
preferably upon the right side for a right handed operator,
the head somewhat depressed, the limbs extended and the
body well stretched. Clip, shave and disinfect a sufficient
area in the exposed flank at a point just anterior to and be-\
neath the external angle of the ilium. With one hand grasp
the skin fold of the flank and render the skin of the region
tense, while with the other holding the spaying knife like a
pen make at first a drawing ii.cision from below upw r ard about
2 to 3 cm. long, ending above at a point slightly below the
external angle of the ilium, the incision extending through
the skin and subcutaneous tissues ; without removing the
knife from the wound elevate the handle and with a quick
thrust make a stab wound extending through the external
and internal oblique muscles and peritoneum at a single cut.
The operator can determine when the peritoneal cavity has
been entered by the disappearance of resistance. Introduce
an index finger into the peritoneal cavity, and as soon as
this has been entered follow directly along the peritoneum
upward and backward toward the angle of the ilium where
the uterine cornua lie covered over by the broad ligament.
The internal generative organs of the bitch are unique among
OVARIOTOMY IN THE BITCH. 1 1 1
our domesticated animals. The uterus, U, Plate XVI, is
very small and physiologically unimportant, the cornua,
RUC and LUC, are ample in size and constitute physiolog-
ically the uterus, the Fallopian tube between LUC and O
is ver}' short and surgically could almost be said not to ex-
ist, the ovary OO is very small, smooth and completely hid-
den in the pavilion which here constitutes a sac having a
very small longitudinal opening of 2 to 5 mm. The most
remarkable feature of the apparatus from a surgical stand-
point is the great development of the broad ligament which
is broader than the distance from the lumbar region to the
abdominal floor, while the uterus and uterine cornua are
stretched between the vagina, V, and the ovary, O, so that
they are suspended in the sub-lumbar region with the double
fold of the broad ligament hanging down like a curtain be-
tween the parietal peritoneum and the uterus and cornua on
either side. The broad ligament of the bitch is consequently
suspended at one point from the sub-lumbar region, at the
other from the uterus, so that instead of the uterus being sus-
pended by the ligament the relation is reversed and the liga-
ment is suspended from the uterus, or rather uterine cornua.
In Plate XVI the right broad ligament BL' is laid out upon
the side exposing the right uterine coriiu RUC, while on
the left side the ligament is divided at about its center and
the posterior portion BL' is laid out on the flank, while the
anterior BL is left in its normal position concealing a por-
tion of the corn u LUC. Unlike our other domesticated ani-
mals, the broad ligament is heavily loaded with fat which
gives it an appearance very similar to the omentnm, but the
net-work is far less conspicuous or wanting. The omentum
also extends back into this region so that the two are in con-
tact. The ovary being indistinct and hidden is difficult to
identify directly, and the cornua being covered over by the
duplicature of the broad ligament is not readily reached, so
that the finger generally comes in contact first with the broad
ligament of the uppermost cornu hanging loose in the peri-
OVARIOTOMY IN THE BITCH.
Abdomen of a non pregnant bitch lying on
the back with the abdominal floor removed and
the omen turn pushed away. TT, the two pos-
terior teats ; B, bladder ; V, vagina ; U, uterus :
LUC, LUC, left uterine "ciornua with a portion
of its broad ligament, BL, lying across it ; RUC,
right uterine cornua with its broad ligament,
BL 7 , turned outwards exposing the full length
of the cornua. On the left side the ligament is
divided so that the anterior half rests in its nor-
mal position while the posterior half, BL X , is
turned back ; OO, ovaries ; R, rectum ; K, left
kidney ; AA, a line indicating the level of the
external tuberosities of the ilia.
O VARIO TOM Y IN THE BITCH. 1 1 5
toneal cavity ; engage this between the end of the finger and
the abdominal wall and draw it out through the wound,
grasp it and continue drawing upon the folds of the liga-
ment, especially upon the median or undermost portion until
the naked cornu appears through the opening, seize it and
draw out the anterior portion until the ovary follows, then
grasp the ovary firmly with the thumb and index finger of
one hand and the ovarian ligament with the same members
of the other hand and tear the ligament through between
them by linear tension. Extend the tear through the
broad ligament as high toward its lumbar attachment as
is convenient and backward to the neighborhood of the uter-
ine bifurcation. Draw upon the exposed cornu until the bi-
furcation appears, when the other cornu is to be grasped and
drawn out through the opening. In young puppies the
securing of the second cornua is very difficult and requires
great care to prevent its rupture. The object may be facili-
tated by pressing the upper flank of the bitch downward,
thereby greatly diminishing the transverse diameter of the
The succeeding operation, 30, avoids this difficulty in a
large measure. Should the distal cornu be ruptured and
with its ovary drop away from the operator, it becomes nec-
essary to turn the animal over and make a second incision
on the opposite side, somewhat further forward. When the
second cornua has been secured draw it out as far as practica-
ble and holding it tense insert an index finger along it until
the ovary is reached, which is recognized by its slightly
greater size and density succeeding the brief neck represent-
ing the Fallopian tube between the end of the cornu and
ovary which are slightly larger, while beyond it, can be felt,
the ovarian ligament. Engage the ligament between the end
of the index finger and the abdominal wall, and with a firm
and vigorous movement, using the finger end and nail as a
curette, rupture the ovarian ligament by drawing the finger
toward the incision, and with the aid of tension upon the
n6 OVARIOTOMY IN THE BITCH.
cornu draw the ovary out through the abdominal incision
and divide the broad ligament as in case of the other cornu.
Remove the cormia with the attached ovaries by rupturing
them transversely near the bifurcation by means of linear
If the bitch be pregnant and especially if far advanced the
uterine coronna will lie upon the abdominal floor, much en-
larged and very much more flaccid than the nongravid uterus
and feeling very much like intestines. The change in the
position of the uterus has caused the unfolding of the dupli-
cature of the broad ligament so that it no longer covers the
cornu. In such cases the operation is performed in the same
way except that rupturing the blood vessels by linear ten-
sion does not insure against hemorrhage and it is necessary
to ligate the ovarian and uterine arteries with catgut or silk.
In cases of pregnancy the entire cornna should be drawn
out and a strong ligature plactd around the uterus or vagina ;
and the ovaries, uterine cornua and their contents be re-
moved en masse. Release the upper posterior limb and close
the cutaneous wound by a continuous suture.
Dangers. Rupture of the uterine cornu alluded to above.
The ureter may be mistaken for the cornu but is smaller,
is closely attached to the abdominal walls, and does not
have the broad ligament with its large deposit of fat. The
kidney is far larger than the ovary, more exposed, and
located more anteriorly.
The iliac arteries are at times caught and ruptured by the
finger but the blunder is uncalled for except through nervous-
ness of the operator.
Unauthentic instances of puncturing the bladder in mak-
ing the incision have been reported and may be possible.
If the bitch has been led out and caused to urinate prior to
operating, the accident is made practically impossible.
O VA RIO TOM Y IN THE BI TCH. 1 1 7
30. OVARIOTOMY IN THE BITCH BY THE LINEA ALBA.
Instruments. Same as in the preceding.
Technic. Confine in the dorsal position with the head
sharply declined. Shave and disinfect an area on the median
line about 6 cm. square extending forward from the pubic
brim. Make an incision on the median line about 4 cm.
long beginning just in front of the pubic brim and extending
forward cutting entirely through the skin, the linea alba and
peritoneum at a single stroke. Insert an index finger and
identify the uterus or broad ligament by its location and
form. The finger usually comes in contact first with the
urinary bladder which may more or less obstruct the pas-
sage to the uterus according to its degree of distension.
When empty as shown at B, it offers practically no obstruc-
tion. When very much distended it may be evacuated by
gentle pressure with the fingers. The operator should be
careful not to draw the bladder out through the incision as
its replacement may prove difficult and its puncture with the
hypodermic needle or an enlargement of the incision may be
necessary in order to bring about its return. Push the
bladder aside if necessary and just above it and below the
rectum the uterus should be readily distinguished and either
it or the broad ligament caught by the finger and brought
out through the incision after which the operation proceeds
in the same manner as by the flank method. It has a dis-
tinct advantage over the flank method in that in puppies
there is not so much difficulty in bringing out the ovaries,
nor the danger of the rupture of the cornua and the ovary
dropping back. By the use of retractors in the abdominal
incision the operator is enabled to >ee the uterus in position
and grasp it by means of forceps, obviating the necessity of
introducing the finger into the peritoneal cavity. The sut-
ures must extend entirely through the abdominal wall and
be carefully placed in order to prevent hernia. Interrupted
sutures are preferable. If the operation has been properly
Ii8 OVARIOTOMY IN THE CAT.
performed no bandage is necessary and the patient will not
disturb the sutures. If asepsis has not been strictly fol-
lowed infection may occur and the consequent irritation
cause the patient to tear the sutures out, which may lead to
protrusion of the intestines or other abdominal viscera. If
the sutures do not include the deeper layers of the abdominal
wall hernia is liable to occur and require a second operation.
31. OVARIOTOMY IN THE CAT.
Instruments. Same as for the bitch.
Technic. The cat may be spayed by either the flank
method or through the linea alba. The point of incision in
either case is the same as in the bitch but owing to the
smaller size of the animal it is necessary to make the wound
quite small. The abundance of hair or fur in the region
renders it essential that an ample area be shaved and the
surrounding hair be saturated with a disinfectant and care-
fully brushed away from the operative area. The cat being
more subject to infection than the bitch the aseptic precau-
tions must be of the strictest possible character. The opera-
tive area must be thoroughly disinfected and cleansed and
equal care must be taken not to introduce irritant disinfect-
ants into the wound. A great danger also exists in the ten-
dency of the abdominal muscle layers to readily become
separated by pressure from the finger and form a pocket in
which wound discharges accumulate and constitute a danger-
ous seat for infection. Great care must therefore be taken to
make a clean incision directly into the peritoneal cavity and
to avoid separating the peritoneum from the muscles or the
muscular layers from each other. The uterus and ovaries
of the cat are naked and far more easily distinguished than
in the bitch, there being no extra deposit of fat in the broad
ligament. The sutures are to be applied to the wound in
the same manner as in the bitch.
TENOTOMY OF THE FLEXOR FED IS TENDONS. 119
IV. OPERATIONS ON THE EXTREMITIES.
32. TENOTOMY OF THE FLEXOR PEDIS TENDONS.
Objects. The relief of contraction of the flexor tendons
of the foot.
Instruments. Razor, scissors, sharp tenotome, bandage
Technic. Tenotomy is generally performed on the deep,
or flexor pedis tendon, seldom on the superficial, or flexor
of the os coronae of the foot.
Confine upon the operating table with the affected
member undermost and the foot fully extended. In default
of a table confine in lateral recumbency and apply an exten-
sion splint to the foot as shown in Plate XVII.
On the median side at the middle of the metacarpus the
skin is shaved and disinfected over the tendon of the flexor
pedis muscle. The location named lies between the lower
extremity of the great carpal sheath above and the superior
extremity of the tendonous sheath of the fetlock below, so
that neither of these is wounded during the operation, but
the tendon is severed at a point where it is invested by loose
-connective tissue which retains the divided ends in their
normal line of direction, somewhat fixed, and favors their
Grasp the metacarpus in this area from above and behind
in such a manner that the thumb rests upon the median or
upper surface of the metacarpus, and the index and second
fingers on the lateral or under side of the flexor pedis tendon.
While the left thumb pushes the skin toward the metacarpal
Done, that is, forward, a sharp pointed tenotome held per-
pendicularly in the right hand is introduced with the cutting
edge toward the hoof through the skin, subcutem and anti-
S 5 --
PERONEAL TENOTOMY. 12 1
brachial fascia down to the flexor pedis tendon. Immedi-
ately on the anterior border of the tendon insert thetenotome
so far that the point of it can be felt on the lateral or outer
side through the skin with the left hand. The cutting edge
of the knife is then turned against the tendon of the flexor
pedis, that is, it is directed backward, the foot is extended
by an assistant with the aid of a rope bound around the
pastern and looped over the hoof, and the extensor pedis
tendon is cut through under light pressure, by the operator
pressing downward on the handle of the knife, using the
metacarpus or suspensory ligament as a fulcrum upon which
the back of the tenotome rests as a lever. A loud crackling
as well as the disappearance of resistance by extension shows
that the tendon is severed. By keeping as close to the an-
terior border of the tendon as possible we can avoid injury
to the common digital artery, the internal cutaneous vein,
and the internal and external interosseous veins which run
between the flexor pedis and the suspensory ligament.
After the removal of the knife and after seeing that there
is a wide space between the ends of the tendon, the foot is
unbound from the splint and a bandage applied to the meta-
carpus, which rests upon the fetlock joint and remains in
position for eight days. Healing of the cutaneous wound
by primary union.-
33. PERONEAL TENOTOMY.
Object. The relief of Stringhalt.
Instruments. Razor, scissors, sharp tenotome.
Technic. On the lateral side of the metatarsus a triangle,
d, opening toward the tarsus is formed by the tendons of the
extensor pedis longus muscle, /, and the lateral extensor of
the foot, <?, which unite on the anterior surface of the middle
of the metatarsus. The synovial sheath of the extensor
PERONEAI, TENOTOMY FOR STRINGHAI/T.
Right hind foot seen from the external side.
The skin covering the lateral extensor of the
foot is laid back in the form of a flap, the crural
fascia divided, e, Peroneal tendon ; f, crural
fascia ; /, tendon of the anterior extensor pedis
muscle ; d, the triangle formed by / and e.
CUNEAN TENOTOMY. 125
pedis longus muscle extends interiorly to near the point of
juncture of the two tendons ; the sheath of the lateral ex-
tensor ends below 3 to 4 cm. above the point of union. In
the middle of this space without a sheath, which is 3 to 4
cm. long, and below the annular ligament of the hock the
operation is carried out. After the skin has been shaved
and disinfected, confine in the stocks or operate upon the
standing horse, with the aid of local anaesthesia, a twitch
being applied to the nose and the opposite hind foot held up
with the side-line. The tendon of the lateral extensor is
easily felt under the skin as a hard cord about .7 to i
cm. in diameter. Stretch the skin and with the back of
the hand toward the hock grasp the tendon with the thumb
and index finger of one hand, insert the tenotome with the
cutting edge toward the foot perpendicularly upon the tendon
through the skin, subcutem and aponeurosis derived from the
crural fascia ; push it from before backward under the tendon,
turn the cutting edge against it, and with the hock extended
sever the tendon as well as the fascia through to the skin.
In accomplishing the section of the tendon the knife is to be
used as a lever of the first class with the anterior border of the
metatarsus acting as a fulcrum. If the tendon has been
completely severed its retracted ends may be felt under the
skin i to 2 cm. above and below the wound. After the op-
eration an antiseptic bandage is applied, resting upon the
fetlock. The bandage should remain eight days and the
cutaneous wound heal bv first intention.
34. CUNEAN TENOTOMY.
Objects. The relief of spavin lameness and as an adjunct
to peroneal .tenotomy for stringhalt.
Instruments. Razor, scissors, straight scalpel.
Technic. Most horses can be operated on standing, with
the aid of cocaine, otherwise cast, or secure on the operating
For the relief of spavin lameness, and as an
adjunct to peroneal tenotomy in stiinghalt.
CT, cunean tendon. The dotted line crosses the
table, on the affected side and extend the tarsus. Shave and
disinfect an area 5 to 6 cm. square on the inferior median
surface of the hock over the course of the cunean tendon of
the chief flexor of the metatarsus, as indicated in Plate XIX.
Locate the tendon, CT, by palpation as it passes obliquely
downward and backward and make a transverse incision
about i cm. below the inferior border of the tendon at a
point midway between the anterior and posterior borders of
the hock, or slightly anterior thereto, the width of the scal-
pel blade. Push the tenotome flatwise between the skin and
tendon, as shown in the plate, force it upwards to the superior
border of the tendon, then turn the cutting' edge toward it
and elevating the handle, using the superior border of the
wound as a fulcrum, cut the tendon through from without
inwards. By firm pressure upon the tenotome in the latter
method periosteotomy is simultaneously accomplished. The
completion of the operation is evidenced by the separation
of the cut ends of the tendon leaving a well-marked de-
pression at the point of operation. Disinfect the wound,
apply an antiseptic bandage resting upon the fetlock and
allow to remain undisturbed for six days. Healing by
General Remarks. Neurotomy is performed for a vari-
ety of objects, such as the relief of pain in a sensitive nerve
itself, as in trifacial neurotomy, u, p. 48, the relief of
pain or lameness in a par: supplied by a sensory nerve, or
the inhibition of motor power, as in the " cribbing" opera-
The following neurotomies are designed to relieve pain
and the consequent lameness dependent upon a pathologic
condition of some part or tissue on the distal side of the
point of operation and to which the divided sensory nerve is
1 30 NE URO TOM Y.
Netirotomy of a sensory nerve is always a painful opera-
tion, and its performance without anaesthesia is unjustifiable
from a humane standpoint, and cannot be so well done either
from the view of mechanical correctness or the carrying out
of antiseptic standards. Some neurotomies can be well per-
formed on the standing animal if it is quiet and the operator
is experienced, the parts being rendered insensitive by
means of cocaine or other local anaesthetics ; in the greater
neurotomies general anaesthesia is called for, whether viewed
from the humane or operative standpoint.
The confinement of animals for neurotomy on the sensor) 7
nerves of the extremities for the relief of lameness is always
to be viewed as a critical procedure for the reason that the
operation is generally made because of the local manifesta-
tion of a more or less general disease which is accompanied
by fragility of the skeleton, and as a result most casting acci-
dents occur in cases of confining for neurotomy or firing in
cases of lameness belonging to the great group of dry
arthritis or spavin family. Casting must, therefore, be done
with the greatest possible care, a id the operating table is to
be constantly and greatly preferred.
Neurotomy is properly a last resort in lameness and should
not otherwise be performed. It has two great and ever
present dangers. If the part deprived of sensation is too
badly diseased to bear the weight and resist the insult result-
ant upon the part being called to do its normal or even an
extra amount of work, it must ultimately give way, the
bones become fractured, the tendons separate from the bone,
the intra-ungular tissues lose their integrity and the hoofs
become detached (exungulation) or other degenerative
changes take place as a result of causing a part to do a work
for which its condition unfits it.
The second great danger occurs from wounds or other
traumatisms to the tissues distal to the operation when the
unnerved parts are not rested as they would be in natural
conditions when injured and as a result reparative changes
are prevented and supplanted by retrograde processes with
ultimate death of the part and of the animal.
Nerves are generally accompanied by satellite arteries and
veins which are always liable to be wounded during the
operation and are more embarassing because of the hemor-
rhage clouding the operation field and inviting error than
dangerous because of the loss of the blood itself. It is essen-
tial to a good operation that the hemorrhage be kept under
control throughout so that each tissue will stand out in good
relief and the nerve reveal its identity in addition to its loca-
tion, size and relations, by its intensely white, nacrous,
striated character, The test of compressing the nerve in
order to identify it by the resultant pain is unsurgical and
Sepsis holds an important place in considering the dangers
of neurotomy because the infection of a sensitive nerve
causes very great pain and if considerable tends to cause a
false neuroma or fibroma in the connective tissue of the
nerve trunk, calling for a second operation in order to re-
move the tumor, and resultant lameness.
Neurotomies should consequently be performed only in
properly selected cases, the smallest possible trunk that will
sufficiently relieve the pain should be selected for the opera-
tion, it should be performed with due regard for suffering
and for asepsis, should be performed quickly and neatly, the
incisions being free, laying the nerve trunk bare without
tearing up the tissues and clouding them and at every point
aim at celerity, accuracy and neatness.
I3 2 DIGITAL NEUROTOMY.
35 DIGITAL NEUROTOMY.
Objects. The relief of navictilar lameness in cases where
plantar neurotomy is not deemed necessary or advisable.
Instruments. Razor, scissors, scalpel, probe pointed
bistoury, tenacula, aneurism needles, bandages.
Technic. Digital neurotomy may generally be perform-
ed on the standing animal, the operative area having first
been anaesthetized by means of cocaine or otherwise, a
twitch applied to the upper lip and the affected foot held up
by the assistant. If necessary because of restlessness of the
animal or inexperience of the operator, confine on the oper-
ating table or cast the animal and apply the extension splint
to the foot to be operated on as shown in Plate XVII, except
that the lower binding cords rest on the metacarpus instead
of the pastern. Extending downwards from the fetlock
joint toward the coronet, between the posterior border of
the phalanges and deep flexor tendon there is a slight furrow,
at the posterior part of which, close to the external margin
of the tendon, lies the median or principal digital nerve ac-
companied in front by the digital artery, A, anterior to
which lies the digital vein, V. Immediately behind the
nerve and generally lying a trifle deeper, is quite commonly
found a second venous trunk of considerable size. Near the
middle of the first phalanx the nerve is crossed externally
in an oblique direction from above to below and from behind
to before by a white ligarnentous band, L, slightly broader
than the nerve extending from the base of the ergot of the
fetlock to the retrossal process of the pedal bone. This must
not be mistaken for the nerve, N, and need not be if it is re-
membered that the latter is accompanied on the same plane
and in a like direction by the satellite artery, A, and vein, V,
enclosed with it in a fibrous sheath. At the uppermost part
DIGITAL NEUROTOMY. 133
of the first phalanx the nerve lies in front of this ligament,
a short distance inferiorly it passes beneath it, while from
the middle of the pastern downwards the nerve lies behind
The operation is practicable at any point over the line of
the nerve from the top to the bottom of the shaved area in
Plate XX or from the superior end of the first phalanx down
to a level with the superior border of the lateral cartilage,
but perhaps preferably at about the middle of the pastern.
At the desired point and over the groove between the flexor
pedis tendon and the phalanges shave and disinfect an area
4 to 5 cm. square. In the center of this area at the anterior
border of the flexor tendon, with the scalpel held perpen-
dicular to the skin, make an incision from above downwards
a distance of from 2 to 3 cm. cutting cleanly through the
skin and subcutaneous fascia down upon the nerve. The
incision is favored by tensing the skin between the thumb
and index finger of the left hand, but care should be taken
not to displace it backwards or forwards. Dilate the wound
by pressure with the thumb and index finger or otherwise
and carefully incise longitudinally the fibrous sheath en-
veloping the nerve and artery. Pass an aneurism needle
beneath the nerve, and follow with a second aneurism needle
immediately beside the first. Draw the two apart, one
toward the toe, the other toward the fetlock, and separate
thereby the nerve from the surrounding tissues. Remove
one aneurism needle, insert a probe pointed scalpel, or scis-
sors beneath the nerve, and divide it at the upper angle of
the wound and excise a section of nerve 3 cm. long. Disin-
fect and bandage with or without suturing the wounds.
Leave the bandage in place 6 to 8 days.
V, digital vein ; A, digital artery ; N, digital
nerve ; L, ligament.
PLANTAR NEUROTOMY. 137
36. PLANTAR NEUROTOMY.
Objects. The relief of navicnlar lameness or other pain-
ful non-suppurating diseases of any parts below the fetlock
Instruments. Razor, scissors, convex scalpel, compres-
sion artery forceps, tenacula, aneurism needles, suture ma-
terial, elastic ligature.
Technic. It is well to apply a bandage saturated with
sublimate or creolin solution to -the fetlock joint 24 hrs.
before the operation in order to secure thorough disinfection.
Confine the animal and fix the limb as in the preceding
operation. After the removal of the bandage, shave the site
of operation and thoroughly disinfect the region of the
metacarpus and fetlock with soap, brush, and sublimate or
creolin solution and 50% alcohol. Passing the fingers from
before to behind with light pressure over the region of the
fetlock joint, there is felt just in front of the flexor pedis
tendon a channel-like depression extending from above the
fetlock downward over it. In this lies the threadlike cord
of the nerve, n, 3 mm. thick, which glides forward under-
neath the fingers with a distinct recoil. The site of opera-
tion lies immediately above the fetlock in the posterior third
of the metacarpus or one may operate at any point higher
up as far as beyond the middle of the metacarpus or meta-
tarsus so long as care ia taken to include the anastomosing
branch given off by the median plantar nerve at about the
middle of the metacarpus and bending obliquely around
behind the tendons to join the lateral nerve somewhat lower
down. At this point stretch the skin between the thumb
and index finger of one hand and make an incision 3 to 5
cm. long, the lower angle of which is just above the fetlock
joint, cutting directly through the skin, subcutem and con-
a, lateral digital artery ; z>, lateral digital vein ;
, common lateral digital nerve ; d, anterior
branch ; o, posterior branch ; s, superficial flexor
tendon ; p, perforans tendon ; /, suspensory
ligament of fetlock ; ;, metacarpus.
NEUROTOMY OF THE MEDIAN NERVE. 141
nective tissue sheath down on to the nerve, laying it bare.
The borders of the cutaneous wound are held apart with
tenacula and by palpation with the fingers or by vision it is
determined if the nerve lies in the middle of the wound. If
necessary continue the dissection with the scalpel until the
nerve is clearly revealed ; it is distinguished by its faintly
yellowish color, its fine longitudinal striae and its location
behind the metacarpal artery. Immediately above the fet-
lock joint the median metacarpal or metatarsal nerve divides
into an anterior smaller, d, and posterior larger, o, branch.
This division should be laid bare in order that the operator
may not erroneously cut one branch only. Immediately
above this point of division the aneurism needle is passed
under the nerve, then a second needle is inserted beside it
and the two pulled apart separating the nerve from the ad-
jacent tissues, the scissors or a small probe-pointed bistoury
is passed beneath and it is cut through quickly at the superior
angle of the wound. The distal end of the nerve is then
dissected free as far as possible downward and both brandies
excised at the lower angle of the wound so that a section
3 to 5 cm. long is removed. The cutaneous wound is united
by a continuous suture and a temporary bandage applied.
The extension splint, if it has been used, is then removed,
the foot replaced in the hobble and the horse turned to the
other side. Neurotomy of the opposite metacarpal nerve is
carried out in the same way after which a sterile bandage is
applied and allowed to remain eight days. Healing by
37. NEUROTOMY OF THE MEDIAN NERVE.
Objects. The relief of lameness due to disease so located
in the anterior limb that it cannot be overcome by plantar
142 NEUROTOMY OF THE MEDIAN NERVE.
Instruments. Razor, scissors, convex scalpel, artery
and compression forceps, tanacula, aneurism needles, suture
Technic. The operation is performed on the median
surface of the anterior limb immediately below the hurnero-
radial articulation on the recumbent horse after the affected
foot has been fully extended on the operating table or in de-
fault of this removed from the hobbles and bound upon the
extension splint as shown in Plate XVII. Anaesthetize.
The foot is drawn out firmly from the shoulder, inclined
somewhat forward. The operator places himself between
the neck and the forearm and, after the median region of
the elbow joint has been washed with soap and water,
searches for the median nerve where it glides over the pos-
terior part of the joint to disappear behind the radius.
Shave the skin at and below this point, disinfect it with
soap, sublimate or creolin solution and 50^ aclohol. The
nerve, n, lies as a rule somewhat in front of the middle of the
median side of the forearm against the postero-internal
margin of the radius and can be felt, about 5 to 6 mm. in
diameter, lying somewhat deeply. The position of the nerve
varies with the different attitudes of the forearm. In fat
and fleshy horses the identification of the nerve is more
difficult. It may be felt upon the standing animal.
With the nerve lying between the thumb and index finger
of the left hand, at the point where it begins to disappear
behind the radius after having passed over the humero-radial
articulation stretch the superposed skin and immediately
upon and parallel to it make an incision 5 cm. long, first
through the skin, then through the sterno-aponeuroticus
muscle. Any hemorrhage from the skin, subcutis, or mus-
cle, is checked. The tenacula are inserted cautiously in the
lips of the wound, and these being drawn apart the white
anti-brachial fascia is brought into view and a search is
made with the index finger to determine the exact location
NEUROTOMY OF THE MEDIAN NERVE. 143
of the nerve, and the fascia is divided with the scalpel and
an oval piece excised with the scissors immediately over it.
If much fatty tissue is found between the layers of fascia it
may be dissected away carefully with the scalpel or cut away
with the scissors. There now comes to view a delicate red-
dish colored fascia-like membrane, the nerve sheath, behind
which a blue cord, the brachial vein, V, is visible, the latter
being intimately connected with the nerve sheath. The
ve'n lies mostly behind and beneath the nerve and may pro-
ject out from beneath the anterior border of the same. The
operator needs be careful not to prick this vein with the
tenacula, as the hemorrhage therefrom is exceedingly annoy-
ing during the operation. It is best to avoid the use of
tenacula after penetrating the fascia and retract the wound
lips cautiously with the aneurism needles instead. Still
further forward and deeper may be felt the pulsating brachial
artery. Incise the nerve sheath carefully and divide it upward
and downward with the scalpel or scissors, whereupon the
yellowish and distinctly fibrous nerve comes into plain view.
Pass an aneurism needle beneath the nerve then pass another
alongside the first and drawing the two apart separate the
nerve from the adjacent tissues throughout the length of the
wound. Be careful to not cut the nerve too high and errone-
ously include the motor nerve of -the flexor of the metacarpus
and the flexors of the foot, which are generally given off pos-
teriorly just below the humero radial articulation. Lift the
nerve up and cut it through at the superior angle of the
wound by a sudden clip with the scissors or with the probe
pointed scalpel. Lay the peripheral end of the nerve bare
to the lower angle of the wound, and excise at least 3 cm.
of it. Tamponade the wound with dry iodoform gauze and
approximate the skin with a continuous suture. The tampon
and sutures remain from i to 2 days.
Since sensation of the lower part of the limb is partly
maintained by the deep branch of the ulnar nerve which at
Median surface of the right humero-radial
articulation, a, brachial artery ; n, median
nerve ; v, brachial vein ; /, antibrachial fascia ;
p, sterno-aponeuroticus muscle.
NEUROTOMY OF THE ULNAR NERVE. 147
the lower part of the carpus, covered by the tendon of the
oblique flexor becomes the lateral plantar nerve, nenrotomy
of the median nerve does not completely effect the desired
end. In order to produce complete anaesthesia, therefore,
from median, it is necessary at the same time to perform
38. NEUROTOMY OF THE ULNAR NERVE.
PI.ATES XXIII AND XXIV.
Objects. An adjunct operation to the preceding by
which the enervation of the carpus and foot is completed.
Instruments. Same as in the preceding.
Technic. Above and behind the carpus there may be
felt a groove between the external and middle flexors of the
carpus, EF and OF, Plate XXIV. At this point 10 cm.
above the pisiform bone the skin is shaved and disinfected
and an incision 6 cm. long made through the skin and
antibrachial fascia. This incision extends just outside the
median line of the posterior surface of the radius in such a
way that the superior angle of the wound is about I cm.
farther outward than the lower. Beneath the fascia between
the aforesaid muscles is seen the ulnar nerve, Plate XXIII,
n, Plate XXIV, NU, on the median or inner side of it
the collateral ulnar vein, Plate XXIII v, and between the
two and somewhat deeper the collateral ulnar artery, a.
The nerve, about 3 mm. in diameter is picked up with the
aneurism needle, severed at the upper and lower angles of
the wound, the lips of the wound united by a continuous
suture and a bandage applied. Healing by first intention.
Right forearm seen from behind. <?, external
flexor of the carpus;/, oblique (middle) flexor
of the carpus ; a, collateral ulnar artery ; d, anti-
brachial fascia ; , ulnar nerve.
Cross section through the radius of the limb
about 10 cm. above the pisiform bone, viewed
from below. EF, external flexor of the carpus ;
OF, oblique flexor of the carpus ; NU, ulnar
nerve ; NM, median nerve. Lying on its median
side is the ulnar artery, the satellite vein of
which is not shown.
SCI A TIC NEURO TOMY. 1 53
39. SCIATIC NEUROTOMY.
PLATES XXV AND XXVII.
Objects. The destruction of sensation in the tarsus and
parts beyond for the relief of otherwise incurable spavin
lameness, diseases of the tendons, etc.
Instruments. Same as in the preceding.
Technic. Place the animal on the operating table on the
diseased side, extend the affected limb and draw the upper
leg forward and secure it out of the way. Produce complete
general anaesthesia. The posterior tibial or sciatic nerve n,
Plate XXV, and NS, Plate XXVII, is then sought by grasp-
ing the leg with the left hand from behind in such a manner
that the thumb rests above and the fingertips below it.
Reaching forward with the fingers to the deep flexor of the
foot grasp the leg with moderate firmness and draw the hand
slowly backward. Immediately behind the perforans muscle
and between this and the tendo- Achilles the nerve nearly i
cm. in diameter glides away forward from between the
fingers with a distinct recoil. If the nerve can not be found
in this manner the hock should be strongly extended, by
which means it is caused to recede from the perforans mus-
cle, so that it can more readily be felt near the middle of the
groove extending between it and the tendo-Achilles. At
this point the skin is shaved, disinfected and an incision
made through it 5 cm. long, parallel to the tendo-Achilles.
The white rigidly-stretched crural fascia is now divided in
the same direction after which it should be determined by
palpation that the nerve lies in the middle of the wound.
Excise with the scissors an elliptic or oval piece of the fascia
or hold apart the fascia along with the lips of the cutaneous
wound by means of the tenacula. In poor horses the con-
tour of the nerve covered only by loose connective tissue
stands out prominently, in fat horses it is surrounded
Right hind leg viewed from the median side,
y, crural fascia; ?/, sciatic (tibial) nerve; v,
o -.5 PL, X
IS 03 w
I s g S
t S iT
03 " ^3 _
bJC - ^
3 o o o
2 '5 3 5
^ <~ PH
2 8 s ^
u Jr >-
CJ 52 *
O w, Jb|
ANTERIOR TIBIAI, NEUROTOMY.
EP, extensor pedis muscle ; P, peroneus mus-
cle ; NP, deep branch of the peroneal or anterior
tibial nerve ; FM, flexor metatarsi muscle.
ANTERIOR TIBIAL NEUROTOMY, 16.3
by a large amount of adipose tissue. Cut through this fat
and connective tissue and the tibial nerve, n t Plate XXV and
NS, Plate XXVII, is in sight, immediately before it lies the
plantar vein and on the lateral side is situated the recurrent
tibial artery SA, Plate XXVII. The cross section in Plate
XXVII is located somewhat below the point for operation
and the vein has crossed obliquely over the nerve so that it
appears behind instead of in front of it, as is the case gen-
erally at the point where the operation is performed. Sep-
arate the vessels completely from the nerve with the handle
of the scalpel, pass two aneurism needles from before back-
ward beneath it and drawing these apart separate the nerve
trunk from the adjacent tissues and cut it off at the upper
and lower angles of the wound removing a section at least
5 cm. long. Suture the cutaneous wound and apply a
bandage allowing it to remain eight days. Healing by first
40. ANTERIOR TIBIAL NEUROTOMY.
NEUROTOMY OF THE DEEP BRANCH OF THE PERONEAL NERVE.
PLATES XXVI AND XXVII.
Object. An adjunct operation to the preceding as it sup-
plies sensation to the tarsus in common with the sciatic.
The two constitute what is known as Bossi's double neuro-
tomy for spavin.
Instruments. Same as in the preceding.
Technic. Confine as in the preceding but with the
affected leg uppermost. Locate the furrow dividing the ex-
tensor pedis longus muscle, EP, Plates XXVI and XXVII,
and the peroneus muscle, P, Plate XXVI, MP, Plate XXVII,
and shave and disinfect the skin over an area 6 cm. long by
3 cm. wide directly over this depression and extending up-
1 64 ANTERIOR TIBIAL NEUROTOMY.
ward from a point 6 or 7 cm. above the tibio-astragoloid
At a point 8 to 10 cm. above the flexure of the hock make
an incision through the skin and subcutis 5 or 6 cm. long
over the line of division between the two extensors of the
foot. Superficially the operator passes near by the muscttlo-
cutaneous division of the anterior tibial nerve, NMC, Plate
XXVII, which must not be mistaken for the deep branch.
The peroneus muscle, MP, Plate XXVII, and P, Plate
XXVI, is separated from the extensor pedis longus, KP,
Plates XXVI and XXVII, by a strong aponenrotic sheath
continuous with the tibial aponeurosis. Penetrate the latter
anterior to the aponeurotic partition directly against the ex-
tensor pedis, EP. and passing along its posterior border to a
depth of 2 to 4 cm., there appears the thin margin of the
flexor metatarsi magnus KM, Plates XXVI and XXVII,
which lies immediately against the extensor pedis without a
visible connective tissue partition but revealing itself by a
markedly lighter shade of color and its ready separation
with the scalpel from the extensor. The deep branch of the
peroneal nerve, NP, Plates XXVI and XXVII, lies loosely
imbedded on the anterior side of the margin of the flexor
metatarsus facing the extensor pedis, at times visible at the
margin, at others placed more deeply reaching in some cases
a distance from the margin of 4 or 5 mm. Within this
range is seen the slender nerve trunk almost devoid of
surrounding connective tissue and measuring about 2 mm.
in diameter. Pass the aneurism needle beneath it and re-
move a piece 3 to 4 cm. long. Close the cutaneous wound
with interrupted sutures and dress antiseptically without a
RESECTION OF THE LATERAL CARTILAGE. 165
41. RESECTION OF THE LATERAL CARTILAGE.
Object. The cure of quittor or necrosis of the cartilage.
Instruments. Elastic ligature, drawing knife, scissors,
razor, hoof rasp, hoof plane, craniotomy or other heavy for-
ceps for the removal of the horn, artery forceps, elevator or
long bone chisel, double-edged sage knife, curette, needle
holder, thread, needles, iodoform ether, iodoform gauze,
tampons, absorbent cotton, bandages.
Technic. For a few hours before the operation place
the affected foot in a bath of creolin solution after having
first made a semicircular groove in the horn of the lateral
wall and quarter down to the horny lamina, as shown at s
in Fig. i, Plate XXVIII.
The operation is performed upon the recumbent anaes-
thetized animal, in such a position that the diseased cartilage
of the affected foot lies upward. The operating table consti-
tutes incomparably the best means of confinement in every re-
spect. After the application of the elastic ligature the groove
in the horn is deepened with the drawing knife 'down to the
sensitive laminae without injuring them. The groove must be
so located that it extends beyond the anterior and posterior
borders of the lateral cartilage, remaining a few cm. distant
from the bearing surface of the wall and approximately per-
pendicular to the surface of the horn wall so that it will form
a secure support for the dressing to be later applied. The
hair on the coronary band is clipped or shaved and the entire
foot up to the fetlock joint thoroughly cleansed with brush,
soap, creolin or sublimate solution and 50 per cent, alcohol.
The levator or long bone chisel is then inserted beneath the
lowest part of the semi-circular piece of horn which has been
isolated, the horn is elevated from the sensitive structures
somewhat, grasped with the heavy forceps and carefully loos-
ened from the sensitive laminae by drawing upward parallel
1 66 RESECTION OF THE LATERAL CARTILAGE.
to the laminae and then backward from the coronary papillae
and keraphyllotis tissue. After the coronary band has been
smoothed vvitli the scissors, make two perpendicular incis-
ions through the skin of the coronary band and the band
itself, one behind the anterior and the other in front of the
posterior border of the groove in the horn and connect the
two by means of a semi-circular incision in the sensitive
laminae. This U-shaped incision must be so made that be-
tween it and the horny wall there is left an area of sensitive
laminae at least 2 cm. wide, in order that there may be suffi-
cient room in the soft tissues for the application of the su-
tures, as shown in Fig 2. The isolated flap is now dis-
sected closely against the os pedis and its ala and later from
the lateral surface of the cartilage, the operator first lifting
the flap with forceps, later with the hand. Above the carti-
lage toward the fetlock the operator must keep the fingers
of one hand against the external skin in order to avoid cut-
ting through it or thinning it too much at this point. The
flap is held turned upwards by an assistant or by a suture.
As a rule there is now seen a prominent, greenish colored
necrotic piece of cartilage surrounded by brownish red
masses of granulations. By means of an incision through
the cartilage parallel to the axis of the foot, divide it into
anterior and posterior halves and extirpate the latter first,
by dissecting it out on the inner side from the parachondrial
tissue with the double-edged sage knife. The point of the
knife must be constantly directed against the cartilage.
Since the inner surface of the anterior half of the cartilage
lies immediately against the capsular ligament of thecorono-
pedal articulation the latter should be sharply extended by
which means the capsular ligament is drawn away from the
cartilage during its extirpation. The anterior half of the
cartilage, k, is then removed in the same way, except with
the greatest possible care to avoid puncturing the corono-
pedal articulation. Remnants of cartilage at its juncture
RESECTION OF THE LATERAL CARTILAGES OF THE os PEDIS.
Horny wall removed, sensitive laminae and cutaneous flap held
upwards. Posterior half of the cartilage excised. _/, sensitive lam-
inae ; 2V, coronary band ; , anterior half of cartilage ; //, cavity
caused by the removal of the posterior half of the cartilage ; n, necrotic
cartilage ;P, parachondral surface of the skin and sensitive laminae ;
s, perpendicular, crescent-shaped incision in the horny wall ;g, fistula.
RESECTION OF THE LATERAL CARTILAGES OF THE os PEDIS.
Completed operation showing the sutures in place and the parts
ready for the application of dressings.
RESECTION OF THE LATERAL CARTILAGE. 171
with the retrossal process of the os pedis, and granula-
tions are to be removed with the curette. Cut away with
the scissors and knife any remnants of cartilage adher-
ent to the flap, p, thin if necessary the entire flap and excise
the fistulous openings, g. After thorough disinfection of the
entire field of operation return the flap to its former position
and retain it there by a sufficient number of interrupted
sutures, Fig. 2, irrigate the wound surface with iodoform
ether and cover the parts over with iodoform gauze and
tampons which rest firmly upon the perpendicular wall of
horn. Finally invest the hoof and pastern up to the fetlock
joint with oakum and lay a heavy tar bandage over it, the
turns of which must completely invest it at every point and
render the dressing impermeable to moisture. Remove the
elastic ligature. If the animal is free from fever, feels and
eats well, the bandage is left in position from 12 to 14 days.
Healing by first intention.
172 RESECTION OF THE FLEXOR FED IS TENDON.
42. RESECTION OF THE FLEXOR PEDIS TENDON.
Object. The removal of necrotic tissues and disinfection
in cases of infected wounds, chiefly of nail pricks of the
Instruments. Elastic ligature, drawing knife, double-
edged sage knife, scissors, tenaculum forceps, curette,
scalpels, tenaculse, bandage material.
Technic. Before the operation thin the horn of the sole,
frog and bars until the soft parts can be seen through them
and apply an antiseptic bandage saturated in creolin solution
for 24 hours if time will warrant. Secure the patient on the
operating table or by casting in lateral recumbency with the
affected foot extended. Anaesthetize. Cleanse and disinfect
the entire foot with soap, brush, creolin or sublimate solution
and 50% alcohol and apply the elastic tourniquet in the
metacarpal or metatarsal region. Make a transverse incision
through the base of the frog 2 to 3 cm. from the balls
through the horny and sensitive portions and the fatty
cushion down to the flexor pedis tendon. Follow this by
two curved incisions extending forward and inward in an
oblique direction corresponding to the semi-lunar crest of the
os pedis, the line of incision being in the bars about ^ cm.
outward from the lateral groove of the frog and uniting at
its apex. This triangular piece of frog which has been
isolated by the incision is now grasped with the tenaculuni
and dissected away. As a general rule the operator finds
that he has not yet reached the flexor pedis tendon but only
the fatty cushion which covers the latter. The remnants
of the fatty frog should be removed with the double-edged
sage knife or scalpel by means of a horizontal incision, and
there is then seen the greenish or yellowish colored necrotic
flexor pedis tendon, which may at times be covered with
RESECTION OF THE FLEXOR FED IS TENDON. 173
reddish colored granulations. Should the operation be in-
dicated on account of a suppurative pododermatitis the bars
on the affected side must be excised along with the other
portions. The position and extent of the navicular bone
can be determined by feeling through the flexor tendon. A
transverse incision is then made over the middle of the
navicular bone through the flexor pedis tendon into the
navicular bursa, the distal end of the tendon grasped with
RESECTION OF THE FLEXOR PEDIS TENDON.
Solar surface of the foot, r, Semilunar crest of os pedis ;
u, os pedis ; r, navicular-pedal ligament ; s, navicular bone ;
b, flexor pedis tendon ; e, sensitive laminae of the bars ; st,
fatty frog ;_/", sensitive frog ; /i y horny frog.
the tenaculum forceps and lifted up from the navicular bone
with the aid of two lateral curved incisions. Between the
inferior border of the navicular bone and the semi-lunar crest
of the os pedis stretches the capsular ligament of the in-
ferior articulation between these two bones reinforced by
dense fibrous bands. The flexor pedis tendon is united to
174 AMPUTATION OF THE CLA WS OF RUMINANTS.
this by a few bundles of fibres. Dissect the tendon carefully
away from the capsular ligament, avoiding opening the
articulation, and beyond from the semi-lunar crest of the os
pedis. If necrotic or discolored pieces of the fatty cushion
or the tendon still remain, remove these with scissors, scalpel
or curette. With the latter, currette the roughened cartilage
of the navicular bone and remove any necrotic portions-
In extensive necrosis of the suspensory ligaments of the
heel and of the ligaments extending from the fetlock
joint to the lateral cartilages, the necrotic portions as well
as the neighboring fatty cushion with its numerous elastic
fibres, must be resected. Disinfect the operation wound,
irrigate with iodoform ether and tamponade it with dry
iodoform gauze. Over this apply a firm pad of oakum,
enclose the entire hoof up to the fetlock in oakum and
apply over this a bandage. Over this apply a tar bandage
and remove the elastic ligature. In the absence of fever
the bandage remains in position for eight days.
43. AMPUTATION OF THE CLAWS OF RUMINANTS.
Uses. The cure of "foul in the foot" or panaritium
when complicated with suppurative arthritis or osteitis.
Instruments. Half round rasp, double-edged sage knife,
scissors, convex scalpel, nrtery forceps, drawing knife,
Technic. Cast the animal and secure the foot to be
operated upon in an extended position, apply the elastic
ligature after disinfecting the claws with soap, water, brush
and creolin solution, rasp away the horn on the lateral side
of the diseased claw, especially at the posterior part of it,
until the horny wall becomes so thin that it can readily be
pressed in with the fingers. Anaesthetize. The corono-
AMPUTATION OF THE CLAWS OF RUMINANTS. 175
pedal articulation can be felt, about 3 cm. below the coronary
band, by grasping the claw with the left hand in such a man-
ner that the thumb rests upon the thinly rasped horn while
with the other hand the claw is moved from side to side.
At the lowest point of the articulation push the double-
edged sage knife into the joint, the concavity of the knife
being directed tow r ard the fetlock, and make a curved incis-
ion at first forward and upward to the neighborhood of the
coronary band, then with strong flexion of the foot a second
curved incision backward and upward which, how 7 ever, ex-
tends only to the navicular bone. By this incision the oper-
ator divides the horn, the sensitive lamina, the external
corono-pedal ligament and the capsular ligament of the
corono-pedal articulation. Pass the knife between the na-
vicular and pedal bones and extend the incision downwards
perpendicular to the solar surface through it, separating the
navicular bone from the os pedis. In this manner the na-
vicular bone is preserved as well as the ball of the heel, the
latter of which is of special significance in healing. The
inner wall of the claw with the powerfully developed corono-
pedal ligament is divided from before backward. After the
vessels which can be seen are ligated, the articular surfaces
of the navicular and coronary bones curetted and the necrotic
remnants of tendon removed an antiseptic bandage is applied
and a tar bandage placed over it for protection. The band-
age remains for 12 or 14 days.
If the structures above this point of amputation are
irremediably involved the digit should be amputated higher
up, at the articulation of the first and second phalanges or
through the first phalanx. In these higher amputations a
flap operation is generally practicable.
AMPUTATION OF THE CI<AWS OF RUMINANTS.
FIG. i. d, horny wall, rasped thin ; g, artic-
ular condyle of 2nd phalanx ; a, b, c, course of
FIG. 2. Median claw preserved. Viewed
from the solar surface outward. , external
corono-pedal ligament ; /, internal do ; k, ten-
don of the flexor pedis muscle ; g, distal artic-
ular surface of the 2nd digit ; g' ', articular sur-
face of 3rd digit ; g" navicular bone ; /, lateral
claw ; m, median claw ; b, bulb of the heel.
v or THE
THE BA YER SUTURE.
44. THE BAYER SUTURE.
FIG. 13 and 14.
Uses. The closure of large or penetrant wounds with
convenient and secure means for applying and retaining
Instruments. Large curved suture needle armed with
strong silk thread, about 20 cm. long, which is doubled and
RETENTION, AND CONTINUOUS APPROXIMATION SUTURES.
d t d' ', d f> ', drainage tubes ; ^, retention suture (closed end); e' ', open
end ; d, fixation suture for the drainage tube ;/~, continuous approxi-
passed through the eye in such a manner that the closed end
extends considerably beyond the cut ends ; small needles
and thread ; needle forceps ; drainage tubing preferably two
very large and one small with lateral openings ; thin wooden
i8o THE BAYER SUTURE.
splints 15 cm. long, 2 to 4 cm. wide, with rounded ends;
iodoform gauze; iodoform ether 1:10.
Technic. After the skin has been shaved over an area
having a radius of 5 to 6 cm. from the wound, the suture
needle is inserted 2 to 3 cm. from the lips through the skin
and subjacent tissues, a strong drainage tube, d' , passed
d, d f , d /f , drainage tubes ; e, retention suture (closed end); e' ', do,
open end ;/, iodoform gauze ; s, splints.
through the closed end of the suture and the thread drawn
tight. If before threading the needle a clove hitch is made
at the middle of the thread, or if threaded as above directed
and the thread is thrown about the tube in a double noose,
the two threads will be kept in contact as they leave the tube
and enter the soft tissues and thus prevent to some degree,
the pressure necrosis otherwise taking place, due to the tense
THE BAYER SUTURE. 181
threads of the suture separating from each other. The
needle is then passed through the opposite lip of the wound
from within to without at the same distance from the lips,
the needle removed, the free ends drawn taut and a single
knot tied against the skin to prevent the separation of the
two threads for the reasons just stated above, the second
large drainage tube, d" , is laid between the open ends of
the double silk thread and these are tied upon it with a
triple knot, after they have been drawn sufficiently tight
that the approximated wound lips form a crest. If the lips
of the wound can be grasped with the hand and held to-
gether in such a manner as to form a ridge 3 or 4 cm. high,
the suture needle can be passed through both simultaneously.
The first suture should be located about 3 cm. beneath the
upper angle of the wound, the other retention sutures follow
at distances of about 5 cm. from each other and applied in
the same way. The lips of the wound are united by contin-
uous approximation sutures like an overcasted seam. This
suture ends at least 2 cm. above the lower angle of the
wound. The third drainage tube is introduced into the
latter and fixed by a special suture. The entire cutaneous
surface lying between the drainage tubes is covered with
iodoform gauze, and between each two retention sutures
there is laid over this gauze the wooden splints previously
cut to the proper size, the ends of which are shoved under
the tubing. The upper- and lowermost splints should be se-
cured to the drainage tubing by means of sutures passed
through them. The entire bandage is finally saturated with
iodoform ether. The bandage and retention sutures remain
eight days, the approximation sutures fourteen.
II. EMBRYOTOMY OPERATIONS.
General Considerations. The following exercises in
embryotomy operations are designed to give to the student
a general view of the subject by a simple plan as carried
out through the aid of a skeleton provided with an artificial
uterus into which are placed freshly killed, newly born
calves in such a position as may be desired and the opera-
tions carried out by the student as described. At the same
time it is hoped to offer through these descriptions to the
veterinary obstetrist a simple and effective plan for perform-
ing embryotomy which has been fully tested by the author
in an extensive obstetrical practice. In describing these
operations we purposely limit the instruments to be used to
the fewest number and simplest kinds, yet using all that are
essential in the performance of any of the following obstet-
rical operations. We designate the same instruments for
each operation. They are : a hooked ring knife ; a Colin' s
scalpel like Fig. n ; an embryotomy chisel i m. in length,
the handle 1.5 cm. in diameter with a ring end, the blade
about 10 cm. long by 4 cm. wide and 2 to 3 mm. thick, the
cutting edge concave from side to side and the corners dull
and rounded ; mallet ; several cotton ropes i cm. in diame-
ter with a small spliced loop at one end.
Object. The diminution of the size of the head on ac-
count of its oversize or of the smallness of the maternal
pelvis, so that it will pass through the pelvic canal.
Technic. In these cases the head is usually engaged in
the canal sufficiently tight that no further fixation is neces-
sary. After thoroughly cleansing and disinfecting the parts
1 84 CEPHALOTOMY.
inject a copious amount of tepid lysol solution into the va-
gina, then carry thr chisel carefully guarded by one hand into
the passage and place it accurately upon that part of the head
of the foetus where it is desired to begin the operation ;
generally on the median line of the nose with the blade of
the chisel standing parallel to the septum nasi of the fetus.
Holding the blade of the chisel firmly against the part with
one hand in such a manner as to effectively guard the in-
strument from slipping aside and wounding the maternal
organs, steady and direct the handle with the other hand
and have an assistant drive the chisel by means of blows of
proper vigor with the mallet into the bones of the face and
head. Do not drive the chisel deeper than the length of
the blade without stopping and forcibly revolving the chisel
upon its long axis and breaking the foetal bones apart.
The partially detached pieces of bone may be torn away
with the fingers or in case the skin is quite adherent to them
the bone may be held with the fingers of one hand, the
chisel introduced with the other and using it as a spatula
separate the skin from the bone. Repeat the use of the
chisel as often as may be necessary in order to bring about
the required diminution of the head, care being taken at
all times to not wound the maternal parts and to conserve as
far as practicable the skin of the face and head in order that
it may protect the maternal parts from the jagged bones
during the passage of the remains of the head. The re-
moval of the partially detached pieces of bone may in many
cases be greatly facilitated by looping one of the cords over
them and having an assistant apply traction sufficient to pull
them away, the operator guarding the maternal organs by
holding the piece of bone during its detachment and extrac-
tion, in the palm of his hand.
Objects. The facilitation of repulsion and correction of
deviation of fetal parts. The operation is generally carried
out when the foetal head is far advanced in the pelvic canal
or has passed beyond the vulva.
Technic. Attach a cord to the inferior maxilla or around
the neck of the foetus and have one or more assistants draw
the head out as far as possible. Make a circular incision
through the skin encircling the head at a convenient point
and separate the skin backward toward the occiput "by forc-
ing the hand between it and the bones or by using the chisel
as a spatula or dissecting it away with the Colin 's scalpel,
continuing the separation over the occiput to the atloid
region. Make a transverse incision below across the trachea
and oesophagus and surrounding muscles and above through
the ligainentum nuchae. Grasp the head firmly with both
hands and twist it forcibly on its long axis rupturing the
articular ligaments and the remaining muscles and other soft
tissues, detaching the head at the occipito-atloid articulation.
The removal of the head greatly diminishes the bulk of the
foetus and it may now be repelled, or deviated parts brought
into the desired position or other operations performed.
47. SUBCUTANEOUS AMPUTATION OF ANTERIOR LIMB.
Objects. Amputation of the anterior limbs is very
frequently called for in obstetric practice especially in
the mare, chiefly in cases of transverse presentation with
all four feet presenting where it may be impossible to safely
correct the deviation, in cases of wry neck in the foal in the
anterior presentation, dprso-sacral position when it is impos-
sible to correct the deviation of the head or in any case in
the mare or cow where deviation of the head cannot
1 86 SUBCUTANEOUS AMPUTATION.
be corrected or is not so readily overcome as is the amputa-
tion of the limb.
Technic. Our larger herbivorous animals being devoid
of a clavicle, the anterior limb is attached to the thorax by
means of the skin and muscles only and is therefore compar-
atively easily amputated. Attach a cord to the pastern of the
limb, the shoulder of which lies most exposed or is most
readily reached and have one or two assistants exert traction
on it and draw the limb out as far as possible with safety to the
mother. Insert one hand armed with the hooked embry-
otomy knife up to the top of the scapula or as nearly thereto
as can be reached, the knife being well guarded in the palm
of the hand which rests against the limb of the foetus ; press
the knife into the skin and subcutaneous tissues and drawing
the hand downward slit them freely and deeply from the top
of the scapula down to the pastern. Lay aside the knife and
force the fingers between the skin and subjacent tissues of
the limb and while the assistant maintains gentle traction
upon the limb separate the skin upward by forcing the hand
or the ball of the thumb through the loose connective tissues
until the upper region of the scapula is reached. The sepa-
ration of the skin from the subjacent parts may require at
certain points, like the olecranon or carpus, the aid of the
chisel or knife to divide firm bands of connective tissue.
This separation of the skin from the subjacent parts has re-
moved the chief source of resistance to the tearing of the
limb away from the body. The next most important obstacle
is the pectoral muscles which should be torn asunder by
separating them into small bundles and tearing them through
with the fingers between the sternum and limb, or the pro-
cess may be aided by incision with a knife or with the chisel.
When these are well divided the remaining impediments to
tearing the shoulder away consists largely of the trapezius
and rhomboldeus muscles at the top, thelatissimus dorsi be-
hind and the great serratus and the angularis scapula which
HUMERO-RADIAL AMPUTATION. 187
only come into action when the shoulder is nearly severed.
It is only necessary then to separate the skin from the limb
and divide the pectoral muscles in order to readily draw the
limb away by traction. Divide the skin now around the
pastern and have two or three assistants exert traction upon
the limb while the operator places his hand against the
sternum and pushes in the opposite direction. The impact
upon the maternal organs due to the traction may be re-
duced to almost any desired degree by applying a repelling
force to the sternum of the fetus so that the impact upon
the maternal organs equals the difference between the trac-
tion applied upon the cord and the repulsion applied to the
fetal sternum. If traction does not bring the limb away
promptly the operator should attempt to extend the division
of the muscles attaching the limb to the thorax while moder-
ate traction upon the limb is continued. Further diminution
of the size of the fetus may now be had by removal of the
other limb in the same way which is especially desirable in
the transverse presentation of all four limbs in the passages
or we may reduce the size of the trunk by evisceration as
described under 53.
This diminution suffices to permit the remnant of the
fetus to be withdrawn with the head deviated to the side,
the total resistance being no greater than had the head and
neck presented normally. This diminution also makes the
foetal body very flaccid, rendering it easy of repulsion and
simplifies the correction of deviations of any parts.
48. AMPUTATION AT HUMERO-RADIAL ARTICULATION.
Object. Amputation at this point is rarely desirable, but
may at times be necessary in the mare in order to remove
an anterior limb when it is impossible, on account of the
position to reach the shoulder.
Technic Attach a cord to the pastern and have an
1 88 DETR UNO A TION.
assistant render the leg tense by exerting moderate traction,
as in the preceding. Introduce the hand armed with the
embryotomy knife, carefully concealed in the palm, and
girdle the skin around the articulation. Passing above the
head of the olecranon on the posterior side, divide the
attachment of the anconean group of muscles with the
knife by cutting from behind forward. Then divide
transversely, as far as possible, the muscles and ligaments
passing over the articulation. Rotate the limb forcibly on
its long axis while strong traction is maintained, and rup-
ture the principal ligaments until the limb is completely
detached and comes away. In cases of limited room it may
sometimes be easier to detach the skin of the limb from the
pastern up to the articulation, as in the preceding chapter,
rather than to girdle the skin at the articulation.
Object. In case a fetus in the anterior presentation and
dorso-sacral position has one or both posterior limbs devi-
ated forward and the feet engaged in or against the pubis,
it is necessary, or at least advisable in the mare, that the
trunk of the fetus be divided in order to bring about delivery
without serious or fatal injury to the mother.
Technic. Secure the two hind feet by means of cords,
if possible, prior to other manipulations. Apply cords to
the two anterior limbs and the head, have one or two assist-
ants draw the anterior part of the fetus as far out as is prac-
ticable and safe, and then girdle the foetal body immediately
against the maternal vulva by making an incision through
the skin and skin muscle. If practicable it is best at this
point to remove one shoulder subcutaneously, 47, and fol-
low with evisceration, 53, in order to give greater operative
room and increased mobility of the foetus. Insinuate the
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192 DESTRUCTION OF THE PELVIC GIRDLE.
hand between the skin and the deeper structures and forcibly
separate it from the foetal body backward until the last rib
is passed, as shown at the curved line on the posterior border
of the last foetal rib in Plate XXX. Force the finger
tips through the abdominal wall behind the last rib and
passing, along the entire border of each posterior rib, separate
the abdominal walls from the ribs and sternum. After the
abdominal muscles have been detached from the posterior
ribs and sternum, and the foetus has been eviscerated, rotate
the thorax upon its long axis which will cause a division of
the vertebral column near the dorso-lumbar articulation and
the anterior portion of the foetus falls away. Secure the
two posterior feet with cords, unless this has already been
done, spread the detached skin which has been pushed back
from the thorax, carefully over the amputation stump of the
lumbar vertebrae, repel these by means of the hand while
an assistant draws upon the cords attached to the feet, push
the remnant of the foetal trunk into the uterus and advance
the feet along the genital passages, thus converting the
remnant into a posterior presentation. Ordinarily this
would result in a lumbo-pubic, which should be converted
into the lumbo-sacral position when its extraction can be
readily brought about.
50. DESTRUCTION OF THE PELVIC GIRDLE IN THE
Object. In somewhat rare instances perhaps more fre-
quently in the cow the pelves of the mother and foetus be-
come interlocked, the antero-external angle of the foetal
ilium I', becoming locked with the shaft of the maternal
ilium I at C in such a manner that any safe degree of trac-
tion fails to dislodge it.
Technic. Remove one anterior limb subcutaneously, 47,
and eviscerate, 53, through an opening made by the removal
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196 AMPUTATION OF THE LIMBS AT THE TARSUS.
of two or three of the exposed ribs. Introduce the chisel
through this opening and carry it back with the hand,
placing it against the shaft of the fetal ilium, I', have an
assistant drive it through the shaft from before to behind
and then withdrawing the chisel replace it against the pubic
brim either at the symphysis pubis or opposite the foramen
ovale, and drive it through the pubis and ischium at either of
these points. The coxo-femoral articulation is thus detached
and isolated so that the entire limb may drop backward
beyond its fellow, the remnant of the severed ilium, I', can
drop downward or move in any direction and the entire pel-
vis thus loses its rigidity and undergoes great diminution in
size so that it can readily be withdrawn.
51. AMPUTATION OF THE LIMBS AT THE TARSUS.
Object. It occasionally happens in the mare, far more
rarely in the cow in the posterior presentation with the hind
limbs retained at the hock that owing to the unusual size of
the fetus or its having been dead for some time, dry and
emphysematous, that the deviation can not be overcome or
its correction would entail an unnecessary amount of labor.
In these cases it is frequently easier for the obstetrist and
safer for the mother to amputate the limb at the tarsus.
Technic. Pass a cord around the leg above the tarsus
as indicated in Plate XXXII and have an assistant hold the
leg steady by gentle traction. Introduce the chisel carefully
guarded in the palm of the hand , and place it against the lower
part of the tarsus as shown between TT. The chisel should
be placed as nearly perpendicular as possible to the long axis
of the metatarsus. The proper direction of the chisel may at
times be greatly favored by placing the cord upon the meta-
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200 INTRA-PEL VIC AMPUTA TION.
tarsus instead of the leg thus forcing the tarsus toward the
sacrum of the mother and tending to throw the metatarsus
straight across the pelvic cavity. When the foetus is in the
lumbo-sacral position and it is desired to amputate the left limb
the chisel should be held in the palm of the left hand with
the back of the hand against the vaginal walls and the
chisel carefully guarded and guided during the entire
operation. Do not drive the chisel entirely through the
hock without removal as it may become caught and clamped
between the divided bones, but drive for a few inches along
the lateral side being sure that the skin on that side is
severed along with the bone, then loosen the chisel by rota-
tion and lateral motion and drive somewhat deeper into the
tarsus until it is completely severed. Withdraw the severed
metatarsus and remove any dangerous spicules of bone re-
maining on the stump and see that the latter is safely se-
cured by a cord passing around the leg above the os calcis.
Repeat the operation on the other hock in a similar manner
using the right hand to guide the chisel. Extend the two
limbs into the passages by traction and effect a posterior
deliver) 7 .
52. INTRA-PELVIC AMPUTATION OF THE POSTERIOR
LIMBS, BREECH PRESENTATION.
PIRATES XXXIII AND XXXIV.
Uses. The overcoming of dystocia due to a posterior
presentation with the hind limbs completely retained in the
uterus, the so-called breech presentation, in cases where the
deviation can not be readily corrected.
Technic. Introduce one hand armed with the embry-
otomy knife through the maternal passages until the peri-
iiaeum of the fetus is reached and make a free incision
through that region involving the anus in the male fetus
and the anus and vulva in the female and enlarge the
^Te R A *>
204 INTRA-PEL VIC AMPUTA TION.
incision sufficiently to admit the operator's hand into the
fetal pelvis. Locate the great sciatic ligament and inserting
the knife at the shaft of the ilium divide the former back-
ward to the perinaeum allowing the pelvic cavity to dilate
freely and giving ample operating room. If the pelvis of the
fetus is too small to admit the hand of the operator at all be-
fore severing the sciatic ligament this may be accomplished
by cautiously cutting from behind forward with Colin 's
scalpel or with the chisel. When this has been severed and
sufficient operating room attained carry the chisel with one
hand and plctce it against the shaft of the ilium as shown
between I' I' in Plate XXXIII as nearly perpendicular to
the long axis of the shaft as possible and keeping the hand
in touch with the chisel blade have an assistant drive it
through the bone until it and its periosteum are completely
severed. Disengage the chisel and then place it against the
symphysis pubis or against theischium opposite the foramen
ovale and drive it through the ischium and pubis at this
point. Using the chisel as a lever, separate the isolated por-
tion of the pelvis as completely as practicable from the sur-
rounding tissues, and with the ringers separate the muscles
from the detached pelvic bone for a short distance on
either side from the severed ends. Carry a cord in and
pass the loop over the ends of the severed section and
tightening it secure the isolated portion of the pelvis and
have one or more assistants exert traction upon the cord
as indicated in Plate XXXIV. The chief obstacle to the
withdrawal of the limb is the great glutens muscle which
should be sought for, identified and torn through with the
ringers at a distance of 5 or 6 cm. from its attachment to the
great trochanter. Other important points of resistance are
the attachment posteriorly of the skin, vulva and anus to
the ischium through the medium of aponeurosis and anter-
iorly, chiefly on the median line, the prepubic tendon ; these
are to be cut, if necessary, with the chisel or knife. Vigor-
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208 INTRA-PEL VIC AM PUT A TfON.
otis traction may now be applied by means of the cord, the
operator in the meantime guarding the most advanced end
of the detached piece of pelvis with the palm of his hand in
order to prevent injury to the maternal organs. Sometimes
this detached piece of the pelvis tears away from the femur
when traction is applied and comes away alone. In such a
case the cord is to be applied over the head and trochanter
of the femur and traction again applied drawing the limb
away in a reversed position, the skin being turned back or
everted as the limb advances until the region of the hock is
reached where the skin does not so readily separate from the
limb and only requires to be cut loose and the limb allowed
to come away. During the removal of the limb the operator
is to constantly note the progress with his hand and sever
by tearing or cutting any tendons or muscles which offer
special obstruction to the work. Repeat the operation upon
the opposite limb in the same manner except that but one
incision need be made through the bone, that is, through the
shaft of the ilium. During the entire work the operation is
carried out subcutaneously or rather intrafoetally and the
maternal parts are amply guarded against injury. The size
of the foetal trunk may be further reduced if desirable, by
evisceration, 53, and followed still further by the introduction
of the chisel guided by the hand and the ribs, on one or both
sides, severed one after another until the chest can completely
collapse and if need be some of the ribs may be removed and
one of the anterior limbs caught by a cord around the scap-
ula and removed intra-foetally. The remnant of the foetus
is to be extracted by means of a cord fastened about the
lumbar region of the spine.
E VISCERA TION. 209
The evisceration of the foetus is frequently desirable in
obstetric practice and has a variety of uses. It decreases
the size of the foetal trunk considerably and permits its more
ready passage through the genital canal, as in the anterior
presentation ; with lateral deviation of the head it renders the
foetal trunk flaccid through the removal of the viscera sup-
porting the body walls and permits the body remnant to be
bent or moved more readily for the correction of any devia-
tions present ; it permits freedom of intra-fcetal operations
directed against other parts, as for detruncation, or for the
destruction of the pelvic girdle in the anterior presentation.
Technic. Evisceration may be variously performed, but
is generally demanded in either the anterior or posterior
presentation and a description of these will suffice.
In the anterior presentation, unless the foetus is far ad-
vanced through the vulva, evisceration is best performed by
the removal of one or more of the anterior ribs. The ribs
are generall}' best reached by the removal of the shoulder,
as already described under subcutaneous amputation of the
anterior limbs, 47. When these have been laid bare in the
manner described the operator can thrust the finger tips
through the intercostal muscles in the first intercostal space
and enlarge the opening thus made by tearing through the
muscles upwards to the spinal column and downwards to the
sternum ; then grasping the posterior border of the rib near
its middle, fracture it by means of a sudden and vigorous
pull. The fractured ends may then be grasped and pulled,*
broken or twisted off. The chisel may be brought into use
if required in order to divide the rib, the hand of the opera-
tor constantly guiding and guarding the chisel blade. The
operation is then to be repeated if required, upon the second
and third ribs in the same manner until an opening into the
210 E VISCERA 770 N.
chest is secured ample in size for the introduction of the
Force one hand through the opening and tear the medi-
astinin above and below from the thoracic walls, and then
grasp either the trachea at its bifurcation or the heart and
tear them away. The heart, which constitutes the greater
bulk of the thoracic viscera, is best grasped in the palm of
the hand, with the ringers engaging the aorta and pulmo-
nary arteries. When the thoracic viscera have been with-
drawn, thrust the fingers through the diaphragm and
locating the liver, isolate the area of the diaphragm to which
it is attached, and engaging both with the ringers remove
the two together. The liver constitutes, in a normal foetus,
the chief intra-abdomiual mass, occupving more space than
all other organs combined. After the liver has been re-
moved the intestinal tube, with its contents, are withdrawn
without difficulty, as its attachments are feeble. The kid-
neys may also be removed.
Evisceration in the posterior presentation is preferably
performed through the pelvis, generally in connection with
52. It ma}' be performed without destruction of the pelvic
girdle by making an incision through the perineal region
and then severing the sacro-sciatic ligament as directed
under 52. When admission has been gained to the abdom-
inal cavity introduce the hand and withdraw the alimentary
tube, then rupture the diaphragm about the liver and tear
away the latter organ in the same manner as in the anterior
presentation. The liver is so friable that it cannot well be
torn away by grasping the organ itself, but comes away en-
tire with the central part of the diaphragm.
Remove the heart and lungs as above directed.
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